Okay, I'd like to call to order this meeting of the Sacramento County Board of Supervisors

for Tuesday, March 25th, 2025.

Madam Clerk, please call the roll and establish a quorum.

Good morning, Supervisors Kennedy.

Eric Desmond.

Rodriguez.

Here.

Hugh.

Here.

And Chair Sonner.

Here.

We do have a quorum.

Thank you, and if you could please recite our statement.

This meeting of the Sacramento County Board of Supervisors is live and recorded with

close captioning.

It is cable cast on MetroCable Channel 14, the local government affairs channel on the

Comcast and Direct TV Uverse cable systems.

It is also live streamed at Metro14live.saccounty.gov and can be heard on 96.5 FMKUBU radio.

Today's meeting will be repeated Friday, March 28th at 6 o'clock PM on Channel 14 and

view at youtube.com forward slash MetroCable 14.

The Board of Supervisors fosters public engagement during the meeting and encourages public participation,

civility and the use of courteous language.

The Board does not condone the use of profanity, vulgar language, gestures, or other inappropriate

behavior, including personal attacks or threats directed towards any meeting participant.

Seating is limited and available on a first-come, first-served basis.

Each speaker will be given two minutes to make a public comment and are limited to

making one comment per agenda item.

Please be mindful of the public comment procedures to avoid being interrupted while making your

comment.

Comments made by the public during the Board of Supervisors meetings may include information

that could be inaccurate or misleading, particularly concerning topics related to public

health, voter registrations and elections.

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made during these public forums.

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To make an in-person comment in person, please fill out a speaker request form and hand

it to clerk staff.

The chairperson will open public comments for each agenda, off-agenda item, and direct

the clerk to call the name of each speaker.

When the clerk calls your name, please come to the podium and make your comment.

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speaker waves their request to speak and the clerk will file the speaker request form

in the record.

The clerk will manage the timer and allow each speaker two minutes to make a comment.

Off-agenda public comments will take place for a maximum of 30 minutes.

The remainder of agenda comments will take place at the conclusion of the time matters in

the afternoon.

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Your comment will be routed to the board and filed in the record.

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or other reasons, please see clerk staff for assistance or contact the clerk's office

at 916-874-5451 or by email at board clerk at satcounty.gov.

Thank you in advance for your courtesy and understanding of the meeting procedures.

Very good.

Thank you, Madam Clerk.

Would you please rise and join DSP Executive Director Michael Alt in the Pledge of Allegiance.

We just took a flag at 916-874-5451 and took a bit of a moment for which it stands

One Nation and under God in the middle with liberty and justice for all.

Thank you, Michael.

And I would like to welcome everyone to today's Board of Supervisors meeting.

Again, as a friendly reminder, we certainly welcome any one that has joined us here in

Chambers to address the board on any matter that is on our printed and posted agenda or

any item that is not.

We ask that you please keep your comments to no more than two minutes that way everyone

has an opportunity to address the board of three so choose.

So with that, Madam Clerk or first item.

First item is public comments relating to matters not on the posted agenda.

We have one speaker signed up that is Larry Lee Roy Ladd.

Good morning.

Good morning, Mr. Cernan.

My name is Larry Lee Roy Ladd.

I'm one of the founders of the City of Ranch Cordova.

But I'm not wearing my Ranch Cordova hat.

I'm wearing my hat as a volunteer researcher for the US EPA sponsored Community Advisory

Group for AirJet Superfunds.

I'd use it.

I'd use it in an invitation to any of the supervisors, staffers or the county executive

anywhere in the county.

If they want to get together and get briefed, if they want to geek out on the toxicology

of the identified contaminants of the air jet because they're all becoming national issues

now, they're getting revived.

And there's a lot of messaging on tricoral effling and India May with the Santact trials

and even perchlorate with measles out in Texas.

So on messaging, they refer to movies or something like that.

And I've been to Wilburn, the leukemia, and I've been to outside in Jeanapolis where

they were fussing about TSE.

And it's really complicated.

So I'm issuing the invitation to, if there's any staffer who wants to chit chat about that,

I'll meet with them at any time.

Thank you, sir.

Very good.

Thank you for the invitation.

All right.

Can I conclude our public testimony and matters not in the agenda?

That does.

Okay, little house thing here.

We are going to, in light of the limited number of public speakers on off agenda, I think

be prudent to take consent at this time.

Assuming we don't have a long list of speakers for consent, signed up.

Okay, very good.

So let's do that.

And if there's no objections from the, my colleagues, then I think that'll make the best

use of our time this morning.

If there are no items to pull, I will move consent items three to 28.

Okay.

It's been moved and second man.

We have any one time to speak.

We do not have anyone signed up to speak.

I do have clerk notes just for item number nine, which is an intro of an ordinance emitting

chapter 16.1 for O, dot O3 of the Sacramento County code relating to the technology cost

recovery fees.

We're waiting for reading and continuing to April 8th for adoption.

Okay.

That concludes your remarks on consent.

That concludes my remarks.

That's correct.

Very good.

All right.

Then we have a motion and seconds.

Please vote.

And that item does pass unanimously.

All right.

Very good.

We will then take our appointments.

For our board to commission, the board is to consent our nominations.

And we are continuing to the meeting of April 8th, 2025.

The Elk Grove Cosumnus Cemetery District, the Equal Employment Opportunity Advisory Committee,

Sacramento County Treasury Oversight Committee, continuing to April 22nd, 2025, the Cemetery

Advisory Committee, Children's Coalition, Disability Advisory Commission, and Home Supportive Services

Advisory Committee, continuing to May the 13th, 2025, the Cosumnus Community Planning Advisory

Council, Delta Citizens Municipal Advisory Council, Maternal Child and Adolescent Health

Board, and Atomas Community Planning Advisory Council.

That brings us to this morning's item.

We are looking at accepting nominations for the Adult and Aging Commission.

There are 10 seats available, Chair Serna.

Yes.

Teeps are recommending the nomination of Solomon Chis, Harrison Linder, Catherine Cos, and

then please continue the remainder to April 22nd.

Thank you.

And Supervisor Rodriguez for the Enelope Community Planning Advisory Council.

We have six seats.

Let's continue this to April 8th.

Thank you.

For the Ferrox Cemetery District, Supervisor Desmond, there is one seat for your district.

Please appoint John Oldham Jr. in way process.

Second.

Thank you.

And that item does pass unanimously.

And Supervisor Rodriguez, I show that you also have one seat.

Please continue to April 22nd.

Thank you.

For the Ferrox Community Planning Advisory Council, Supervisor Desmond, you have five seats.

Please nominate James Crawley and continue the rest to April 22nd.

Thank you.

For the local child care planning and development council, Chair Serna, there are six seats available.

Chis are recommending the nomination of Aubrey Boudelli, and please continue the rest to April

22nd.

Thank you.

Chair Serna also for the Public Health Advisory Board.

There are three community member seats.

Please continue to May 13th.

Thank you.

Supervisor Rodriguez for the Realunda El Verdo Community Planning Advisory Council.

There are two district four nominations.

Please continue to April 8th.

Thank you.

And lastly, for the Sacramento County Youth Commission, Supervisor Serna, for district one, you have one seat available.

Please reappoint Justin Heng and wave the process.

Second.

And that item does pass unanimously.

Supervisor Kennedy, I assure you have one seat available for district two.

Yes, please nominate El Brzozki.

Thank you.

Supervisor Rodriguez, you have one seat for district four.

Please continue to April 8th.

And Supervisor Hume, one seat for district five.

Please continue to April 22nd.

That concludes our Board's and Commission's nominations and appointments.

All right, very good.

All right, we have some time, so we will recess until 1015 to take up presentations.

Thank you.

I'd like to call back to order this meeting of the Sacramento County Board of Supervisors for Tuesday, March 25th, 2025.

Men clerk, will you please call the roll and reestablish a quorum.

Thank you.

Supervisor Kennedy.

Here.

Desmond, Rodriguez.

Here.

Cue.

Here.

And chair Serna.

All right, very good.

Do you have a quorum?

Thank you.

Next item, please.

Item number 10 is a presentation of Resolution Honoring Photography Month Sacramento for outstanding contributions to the arts and culture in Sacramento.

Director of the Sacramento County.

Good morning, colleagues and members of the public that have joined us here this morning.

For me personally, this is a very exciting part of our business today.

This is a resolution honoring photography month in Sacramento for outstanding contributions to the arts and culture in Sacramento County.

I'm joined by Roberta McClellan, who is the executive director of Viewpoint Photographic Arts Center here in Midtown Sacramento.

And I'm a proud member of Viewpoint and have had the honor and privilege of having some of my work displayed at their gallery.

But I think many of you are well aware of my personal passion for this art medium.

And in fact, I was with a few of you this past weekend where I took the next step about 3,500 photos at the California Capitol Air Show.

Way too many photos.

In fact, my left arm is sore from from hoisting a fairly heavy long lens.

But I wanted to make sure that I was here this morning to enjoy Roberta.

This is a fantastic way in the month of April to highlight the medium of photography,

not just as it relates to the gallery, but to all photographers and aspiring photographers, especially our youth here in the Sacramento region.

And while Viewpoint is a noted gallery space where photos are shared and certainly workshops are held.

And there's all kinds of other services that Viewpoint offers local hobbyist photographers, but also professional photographers.

But it's really the education part that inspires me to be here today to present the resolution.

We are in certainly Roberta can share with you in greater detail, but we are going to be seeing even some public

acknowledgment of April as being photography month.

But we wanted to kick things off this morning with the resolution and anticipation of the new month coming up just next week.

I won't read all the where-as is or the resolve, but be sure that we try to capture in the verbage here what the month means.

And with that, I'd like to present this to Roberta and then offer her the microphone.

And for our photographers, you're welcome to come up to the stairwell because we're going to be facing that way so you can get that in the background.

Good call.

Photographers perspectives.

Great, thank you.

Thank you so much for all this is fantastic.

Thank you very much. This is a real honor and I'm not sure how many of you have heard of photography month.

We started it back in 2018 and then a thing called COVID hit so that shut us down pretty hard, but we pivoted and turned it all online.

Photography month was created. It's a grassroots program.

The idea was to reach out to our community, our galleries, our businesses, our museums, our schools to encourage them to celebrate the art of photography.

And also our photographic artists, many of whom are right here in our county.

This is the most robust offering of the photography month programming is right here in Sacramento County.

And it is just a amazes me every year when I see how many people come forward with their artwork, their creativity, their ideas, their enthusiasm.

And one of the things that Phil mentioned, the educational component.

Every year viewpoint does a student exhibit.

It's an open call. This year finally we're building some tremendous momentum here.

We had over a hundred students apply from throughout the county so it's really exciting.

The Crocker Art Museum is our partner in this.

I also wanted to do a shout out to Sacramento 365 and visit Sacramento for providing us with the online calendar services that highlight all of the events that are occurring.

And if you go to photographymonthsacramento.org, you can learn all about photography month and all of the events that will be happening throughout the month of April.

So thank you all very much, really appreciate it. Thank you Phil.

Supervisor Serna, this is a great honor. Thank you.

Thank you.

All right.

I assume we don't have any other public speakers on the matter.

We do not.

Okay. Very good. All right. Next item please.

Our next item is at 1030 and so we need to take a racist but we can also do our own ranks appointments if you'd like to do that at this time.

Sure.

So item number 38 is the Board of Supervisors 2025 appointments from own ranks.

Disacramento County Diversity Equity and Inclusion Cabinet.

We are looking for a nomination and appointment for the ex officio Board of Supervisors members currently seated as incumbent is yourself.

I would be happy to continue serving on the DEI committee.

Thank you. There's a motion and a second.

Please vote.

Yes. We've been busy.

And that does pass unanimously.

But I share your concern.

Okay. So that concludes on ranks.

That is correct.

Okay. Then we will stand in recess for eight minutes.

Thank you.

Okay.

To call back to order this meeting of the Sacramento County Board of Supervisors for Tuesday, March 25th, 2025.

Madam Clerk, please call the roll and raise the tax form.

Supervisors Kennedy.

Here.

Desmond Rodriguez.

Here.

Hughes.

Here.

And Chair Surnon.

Here.

Next item please.

Item number 33 is PLMP 2024.

Actually, it was 0229 2030 General Plan Annual Report for calendar year 2024.

Morning.

Good morning.

My name is Jacob Dodd.

I'm a senior planner with Planning and Environmental Review.

I'm going to be talking about the 2024 General Plan Annual Report today.

So as a very, very brief reminder,

planning compiles the annual progress report on our ongoing general plan

implementation on an annual basis.

So we come around this time of year,

presenting here to the board, and then we kick it up to the state by their deadlines.

So with that, let's go ahead and just dive in with some of our major projects and programs

that we focused on in 2024.

So first and foremost, the cap.

So the cap was after many years of hard work was adopted in November 2024.

And so with that, the kind of real work now begins here in 2025.

So the county executive office met earlier this year to have a kickoff meeting for

cap implementation. I'm start working on which departments are going to do what?

I'm wondering how monitoring is going to work and all that.

So cap limitations going to kick off kind of in earnest now here in 2025.

For the EJ element, we continued our implementation and our stakeholder outreach,

especially through our annual stakeholder meeting 2024.

But I wanted to highlight that the county applied and was successfully awarded

say COGS Engage Empower Implement or EEI grant last year.

So this is a grant where we partner with a local CBO.

It's going to let us do a lot more robust and in-depth engagement in the North

Highlands EJ community. So we're very excited about that.

Moving on to Enfield. So the board last year, early last year, had an Enfield workshop

where a lot of different ideas were discussed on how to spur Enfield and housing development

in the county that turned into a resolution of intention and then an actual adopted Enfield

program in 2024. And further inst of those efforts and some of the directives that came out of

those, the county applied and was successfully awarded the pathways to removing obstacles

to housing, the pro-housing grant from the federal Department of Housing and Urban Development.

So the county was awarded about $2.7 million and those are going to go towards

several Enfield and Housing related efforts, including infrastructure studies and land use

plan updates for the Stockton Boulevard and North Watt Avenue commercial corridors.

We're going to be looking at adaptive reuse, so commercial to residential conversions

and then furthering housing streamlining and our different SPAs.

Moving on to housing element implementation. So 2024 was the fourth year of the current

housing element cycle and we successfully completed several housing element programs in 2024.

So that's includes the countywide rezone, the Enfield program update as I just mentioned,

and then also the farm worker housing and supportive living ordinance amendments.

So those were all identified housing element programs in our action plan.

Also in 2024 we received five new capital A affordable housing projects in the middle,

and so those projects altogether total about 265 residential units,

235 of which are de-districted for low to very low income residents and families.

So we're very excited about keeping those moving through the process and then getting those

built out here very soon. This table here shows our progress on meeting our state allocated

regional housing needs allocation. So this past year in 2024 we issued residential permits

for just under 1200 residential units. Can I interrupt here? Of course.

What can you share about how the numbers on the far right column have changed relative to each other

over the past several years? I think most folks that are perhaps unfamiliar with the RENA process

and the RENA mandate may assume that it is all about seeing that below market rate housing,

everything below above moderate or below moderate is what's desperately needed. This tells us

the story that above moderate as a category is got the highest remaining RENA need.

Yeah, so I'm sorry if you could rephrase the question. So that the remaining RENA that the

highest is still in our above moderate. Right. So they find that surprising. So what can you tell us

like to say, maybe you just anecdotally over the last decade have those numbers for above moderate

specifically gone up proportional to the other categories? I don't know for a certain

proportionality. But not in yes in the gallery. Yeah, really curious. I guess. Okay. All right. So our

experts in the subject are confirming that what I suspected and I just would just point that out

because they're rightfully is a lot of focus of course on affordable housing and the various

categories that comprise what we generally consider to be affordable, moderate, low, very low,

extremely low even that's not on here. But I would just point out too that our housing crisis

really is not playing favorites here. It's all a crisis including the fact that we have shortages

for above moderate housing as well. Supervisor Rodriguez. Hi, good morning. So as I was listening to

chair sir now and you can see that the above moderate is on is on it gets doing well. But

the very low is that 30% AMI is that correct? Very low. I believe. Yeah, I believe so. Which just

for clarity is some of our greatest needs throughout the county. Yeah, I think I'll add that a lot

of the numbers we see come in come from build out of projects that were previously entitled. And so

a lot of the reforms that the county has made have kind of been within this cycle that's kind of

what our housing all of our housing element programs have been focused on as well. And so often you

know it could take a couple of years for those extremely low those very low units to come in. So like

I just mentioned receive five new submit projects this year which propose you know over 200 units in

that very low to extremely very low income level. So that's you know that's all triple the units that

we've had so far that we're potentially going to see within the next one to two years. And we have

even more affordable projects that have been recently entitled are still going through the process

you know proposed in previous years. So I think as we move kind of through this housing element cycle

those numbers are going to go up. We're getting more and more projects coming in the reforms,

these housing element programs that we've but the board has adopted are kind of going to affect I

think we're going to start to see those numbers increase for the very low for the very low. Yeah that's

what we've been seeing and it's kind of some of our more recent submittals within the last year. Okay thank

you. Supervisor Desmond. Thank you. And do these include the numbers for the project home key

conversions? I believe to these Nathan Alakis will turn to you. I believe they do. We just don't

go through our normal submittals right. The project home key. Yeah the building yeah because they

still receive the building permits that's what these numbers are based on our issued building permits.

Home keys are just kind of exempt from our entitlement and sequel process but they still I believe

these include our home key conversions. Okay I'm going to get that's a case. Converting

confirmation that because I was wondering they probably do okay see Todd it's a good question.

Okay thank you. I will also just take this time this interruption in your presentation to

just remind everyone because we did receive some correspondence. I think we all did yesterday

which of you know tends to happen every time we're considering our arena needs

that there's a presumption that we build housing in the county. We don't build housing in the

county and then rena exercise state requirement is identifying sites and appropriate zoning,

appropriate densities essentially making sure that we live up to our responsibility to be prepared

to accommodate housing at these various income levels but when advocacy letters begin with

we are falling fall short in our production of housing. Again it just I think warrants a bit of a

disclaimer that and reminder that the county itself cities themselves they don't produce

the housing. Our housing authority certainly has that responsibility and certainly the

nonprofit below market rate housing industry and the market rate housing industry or the parties

that actually produce the housing make the events investments and that ultimately and hopefully

affect lower housing needs across all income categories in the future but I think again

it deserves mentioning that we're not in the business of actually constructing producing the housing.

And if I may add Dave DeFonte deputy county executive your board's done a lot over the last

couple of years to facilitate all types of housing and as you've noted you know that we've I think

we're trending in the right way on most of these categories but there's still a lot we could you know

be improving upon really as a whole again the county's role and the boards in particular

rezoning properties you know your board did rezone a whole host of properties this last year to

accommodate more affordable housing and housing of all types there's a phase two to that project

coming to your board in the next year or two as well that will contemplate rezoning even more sites

but we do have a surplus right now so there are adequate sites within the county to develop upon

but as you'd mentioned the county's not in the business of actually building things but we are

very much in the business of making it easy to build here and your board's done a lot over the last

couple of years to do just that and as mentioned earlier we're going to be coming back with a suite of

proposed zoning code amendments along that line as well per direction we got from your board last

spring to again become the best place to build in the region and I think we've made a ton of progress

over the last couple of years to that effect but there's always more we can do and continuous

improvement is one of our mantras and we're going to be doing just that thank you Dave for that

reminder supervisor Desmond thank you and I was going to mention talking about some of these things

at the end but it seems most appropriate here so I appreciate you bringing those points up because

I think it's a matter of the county removing those obstacles that you're referring to Dave

and controlling the things that we can control but there are only so many things we can control and

and some of the costs of things whether that's mostly the infrastructure related costs that's where

we work and go after grants to try to help with some of these things as well so I really appreciate

the work you're doing the amount of attention that we're showing to this one thing that would be

helpful to me and I was thinking about this as I was reading the looking at this chart in particular

do you have a sense and maybe get back to me get back to us at some point about how we compare

with other jurisdictions similarly situated jurisdictions counties or cities on most counties

aren't like us I know that with the unacorporated area but I think that would be really really

helpful to see where we are in relation to other municipalities and just for clarification is

that relative to Rina related progress or more generally I think Rina relevant to this slide would

be very helpful for me to see and to the extent we made there may be a big divergence between us

and different jurisdictions a little bit of context why that is why we're doing better or why we're

maybe facing some additional obstacles yeah and we're happy to put that together I'll say anecdotally

I know a lot of jurisdictions are looking at charts just like that and they're saying why can't we

do things better like Sacramento County that's exactly right

supervisor Rodriguez thank you Dave for the information so you mentioned we have

stone locations for this housing so and we have a major shortage of housing currently right now

for all levels of affordable housing so is the shortfall in that we don't have developers that

are ready to take on some of this housing is that where the bottleneck is that's a really big

question I'll give you at least my my sense of things we've spent the last gosh at least decade

master planning some very large areas those areas are now on the precipice of developing so

Braden for example next to Rancho Cordova I was working on that project over 15 years ago we're

now doing mass grading out there right the Jackson highway master plan areas three of the four

there are now approved master plans and the fourth is coming to your board in a couple of months

for consideration so we spent a lot of time working on the nuts and bolts at the master planning

level and only now are we seeing them start to actually go vertical so I think that's been one

of the big constraints we see just across the region a lack of finished lots to go from you know

the master planning phase to finish lots where the production home builders are able to purchase

lots and actually building and build on them takes many years oftentimes decades to accomplish

and region wide we just have a dearth of those finished lots and that's primarily on the single

family of a family front on the multi family front we do have now a lot of adequately zone sites which

is typically already 30 and above so 30 dwelling units to the acre because you're bored approved

a lot of re zones this past year and more are going to be proposed in the future you know really

it's difficult to pull some of these projects off especially in infill areas it's expensive

especially when you're looking at infrastructure deficiencies whether that be sewer water roadways

etc so that's one of our focus points moving forward this next year is hiring an infill coordinator

and working on knocking down some of those barriers I think we've done a lot of really good

planning in those areas but now we're really digging into what are the true constraints that are

in the way of making those areas actually pop and figuring out ways to eliminate those barriers

how do we actually address that sewer constraint that water constraint so the next developer that

comes in doesn't have to be shouldering the entire burden of fixing a sewer constraint that affects

a two mile stretch right but having a program in place to make sure that we can be addressing

those more holistically so they're not on the shoulders of individual projects when they come in

thank you and you're referring to just general housing correct yes yes so my question is more

related to the affordable housing the low income if we have zoned locations is the

shortfall that we don't have enough affordable housing developers to take on these projects or

is it on the funding side yeah we have we have an excellent cadre of affordable housing developers

in this region I don't think there's a shortage of experienced developers I think the

constraint is funding you know in particular those 9% tax credits you know affordable housing

financing is an incredibly complicated beast and very very competitive so if there were more money

available I'm sure you'd be seeing more units pop out of the ground but it is a very competitive

landscape for those dollars yeah that's definitely what I am experiencing as I look into the

the building of affordable housing as I mean it's the shortage is it's really crisis level and

yeah it's definitely a pain point thank you thank you you probably want to get along with

your presentation sounds good sounds good okay where are we at implementation measure status

report yes okay so this slide here I guess I'll do a reminder due to the size of our general plan

and I think we leave it over 600 implementation measures we're not able to kind of do kind of

annual check-in on every single implementation measure every year so we break them out and we

review one element per year and you know show if they're completed some progress is made or not

started and that's what the slide shows here it's kind of a point in time of when each of those

elements have been reviewed so so far we've completed over a third of the implementation measures we

reviewed the remaining are either not started they're either ongoing or some progress has been made

or they're no longer relevant or applicable so this year we reviewed the air quality element

and so I just wanted to give a few highlights that we found from that review so first off of course

is the cap so the cap is going to serve as our greenhouse gas reduction plan which is one of the

measures identified in the air quality element we are developing air quality management plans on

a project by project basis so the element kind of alludes to having a countywide management plan

but after staff kind of reviewed and also working with the air quality management district to

determine that kind of the best approach is really to do this on an individual project by project

basis so you kind of get the kind of individual mitigation that you need that the project you

know requires and allow staff and the developer kind of more flexibility so that's been a big

big achievement and we do do those plans as needed and then lastly here I wanted to highlight

actually the work of the Department of General Services and the work they've done to kind of

green our fleet so the Sarcoma County is actually ranked one of the top 20 greenest fleets in

America by the National Association of Fleet Administrators and has actually reached the number

number one spot on that list in 2018 so the county is over 700 hybrid vehicles over 30 fully

electric vehicles and four hydrogen vehicles and over 60% of the county's fleet fleet's total

fuel consumption comes from alternative and renewable fuels so they've been doing a lot of great work

to kind of lead in kind of making sure our fleet is kind of as carbon neutral and reducing our

emissions as much as possible so I wanted to highlight that here as well also was an implementation

measure in the element. Okay so on to growth strategies so kind of back on to housing a little bit

with the county general plan identifies various growth strategies for where we're going to kind of

put our resources and how we're going to grow our housing and our population so it's in fill

which is vacant under your lies parcels and our commercial corridors are approved growth areas so

these are more largely like our green field areas and then our pending master plans so in 2024

well for infill and we've already kind of spoken a little bit about some of the work we've done

there so I don't want to go over all of that again but all of that work is going towards this

infill growth strategy that's in the general plan. Our growth areas so that's still kind of where

we're seeing the use the plurality of our development and a lot of the development is in the vineyard

area so we are tracking build out of a few specific clan areas there in vineyard you can see their

remaining capacity on the slide and then we also have our pending master plans which I'll cover in a

couple slides. So this table here is our approved growth area so those green field areas so

those getting each kind of what Dave was seeing earlier in that we have done a lot of the planning

work so these are all plan areas that have been fully entitled and approved and you know kind of

units just kind of waiting to be built once we work through all the rest of the development process

so these are units kind of coming down the line just when when they're ready to go

and then lastly we have our pending master plans so these plans are still in

prer being processed by planning they're going through you know the various stages but these are

proposed units once these master plans are approved these are potential units that we will be adding

to the county. This slide is updated year to year you know based on how the plans are refined so

again these are pending. Okay zoning code updates so if you remember back in 2022 the board had a

workshop discussing kind of planning's workload and prioritizing various zoning code amendments and

requests that they received since that workshop planning has completed five zoning code updates

made significant progress on five more and recently initiated additional six so a lot of work

coming out of our zoning administration team to kind of monitor you know continue to update our

code and make improvements there so a full list of that an updated kind of priority matrix is

included in the agenda packet as well as a list of SPAs and MPAs currently being considered for

review revision and or potential resisions so those are we're kind of finally taking in that magnifying

glass look at all those SPAs and MPAs triaging them out and then going to be making amendments based

on what's needed there. Okay so almost done so going on for the work program for this year.

So we kind of bucketed our five priorities here and so I'm going to give a little bit just a very

brief overview of the work we're proposing for each of these so capital implementation so as I

mentioned before this is the first full year of our implementation of the cap so we're going to

be kind of working on all the kinks and then prioritizing a variety of implementation measures in order

to meet the state's GHD reduction targets. For the housing element there's four housing

element programs that we're going to continue work on in 2025 so as I mentioned just now we're

going to be looking at updating or rescinding those SPAs and MPAs and that also includes our

affordable housing ordinance amendments so we're very in the very very early stages of that effort

we're kind of in the data collection phase but we're looking to probably start our committee

outreach feedback here within the next couple of months and then we're going to come into to

the board here for a workshop to kind of reveal our findings straight the feedback we received and

then to get some policy direction from from the board. For infill we've been talking about infill

already but I'll just say here again through that pro housing grant we're going to be expanding the

scope of our work on north-wide and stocked in to include infrastructure assessments and hopefully

maybe even come out with maybe specialized capital improvement plans for those areas and then

also look at land use revisions for those those planning documents. Planning is also going to be

working on several infill related zoning code amendments as Dave mentioned and like looking at

you know again the adaptive reuse ordinance and also looking at our commercial and multi-family

development standards see what we can change there to spur development. For EJ staff's going to

continue to conduct our working groups do our trainings here with county staff and then have our

annual stakeholder meeting and then as mentioned earlier we're going to be implementing the EEI grant

so we're going to be kind of getting our boots on the ground in North Highlands to kind of do a

lot more meaningful engagement out there. And then lastly on here is our general plan legislative

updates so the state has passed a mymiriad of bills in the past couple of years requiring various

changes to our general plan elements and so this year we're going to be probably taking a closer

look at the open space and the circulation elements and the bills related to those so there's going

to be more forthcoming on those two efforts here later this year. One last thing I wanted to mention

before we move on to recommendations is that the 2030 planning horizon for the current general plan

is now only five years away and we are due for a general plan update. The community development fee

study is currently in progress and long range planning fees is of course a part of that and we're

looking to update those fees but those fees alone are not going to be able to fund that effort

and so additional either general general fund allocation or grant funding is going to be needed

if we're going to be able to do a full general plan update.

Okay recommendations so staff recommend the board receive and file the 2024 annual report

a direct staff to submit the annual report to the governor's office of planning and research or

land use and climate innovation or whatever they're calling themselves now and the California

Department of Housing and Community Development and then also direct staff to proceed with the

implementation of the general plan and to include the project that line in the work program and the

annual report. Thank you. Thank you. Great presentation thanks to all of our planning staff that

have been working on this and at this point I would ask my colleagues if they have any questions

or comments they haven't already said or asked. Seeing none I'm sure to have any members of the

public that are signed up to speak on this matter. We have one member of the public signed up to

speak Mr. Mike Jasky.

Morning Mike. Good morning chair Serna and supervisors. I'm Mike Jasky representing Sacramell

Area congregations together. Specifically it's housing and homelessness committee. As you know

Sac act is a multi-faith multi-ethnic social justice organization and our different faith traditions

share in common desire to act compassionately or the poor and downtrodden. Today I'm just going

to summarize the more detailed letter that we submitted yesterday focusing on the housing element.

First actually may I indulge your permission to have the clerk put up slide five of

Jacob's presentation. That's the cable. You spend a lot of time talking about. Metro cable can

you please recue slide number five of the last presentation. While that's coming up

let me just note that from the perspective of an advocate the extremely low the very low the

low are grossly behind schedule. Yes all those various comments that you made earlier you know there

are reasons but there are people who need housing. There are people who are on the street who need

affordable housing. There's a connection between the amount of affordable housing the number of

who are and otherwise disadvantaged people who need affordable housing who don't have it who are

on the street today. There's a need for affordable housing for people now in permanent supportive

housing who can't get out of it because they can't afford to move to anywhere on their own. They

don't need the services of permanent supportive housing anymore but there and that just slows the

progression of homeless people through the system. So while it's a complicated process to develop

affordable housing it has severe consequences for thousands and thousands of people not just in

the unincorporated jurisdiction that you control but throughout the county.

So we reviewed the housing element progress report that was an attachment to the documentation or

the documentation. Yes there's progress on many of those elements but as Jacob summarized sort of

very broadly there's others that are behind schedule not even started according to the original

schedule that was established. You need to figure out how to get more attention to this issue

and that comes from you. There's resources that are constrained in the community services

part of the staff if that's the issue figure out how to hire the appropriate number of staff so

those things many of them very meritorious can actually move forward and so that we have some

chance of solving this. Can you add a concludes your remarks please Mike.

Let me just wind up by saying people are on the street people who are going to be on the street

can't afford to wait for the five 10 15 years to build out these major projects. There's got to be

a way for the county to figure out how to streamline its rules how to create processing incentives

if not direct financial support to get affordable housing moving. Thank you Mike.

And finally let me wrap up by saying all people deserve decent housing and the whole community

is better off if we all have it. Thank you. Thank you. And I'll just respond by saying I think to a

person up here we don't disagree with anything you've said we are most aware of the housing crisis

we are most aware of the fact that we still have way way way way to many people that are unhoused

on the streets in our parkways under our overpasses. I for one I'm very proud of our staff as it

relates to their commitment and their dedication and their creativity when it comes to

not just the funding and finding resources to help us advance our desperate need to bring people

out of those circumstances of homelessness but that extends certainly from our social service

side and public health side to our planning and building and community development and economic

development side equally proud of our team as it relates to their commitment and their creativity

and their dedication again to fulfilling what we have an obligation to do which as I mentioned

earlier which is not necessarily producing the housing that's not what municipalities and counties

do but for maximizing the opportunities for all types of housing including very low and extremely low

investments and you know it's not lost on us that this is something that is a very high priority remains

a high priority for us we can all mention in our respective districts where we are making progress

the depths of the challenge is great but I for one and just extremely proud of our county team

because they've taken it about as serious as it can be taken. Supervisor Gui. Thank you chair

as one who spent a good portion of my career in the home building industry and in development in general

I have a little bit of knowledge in this area and I appreciate the comments made about continuous

improvement and I appreciate the comments from the chair that the county doesn't directly control

the production but I will say this that in just like in many industries housing is a supply and

demand economy and to the extent that you want to bring home prices down lower case a affordable

not uppercase a affordable which is very complex when you get into the different financing stacks

it's it's really a numbers game and the one thing that the county can control is how difficult

or easy the process is and so I would recommend that as we undertake this and we really try to

be the tip of the spear and the best place to do business that we look at our own processes

and how much we act as a gatekeeper versus how much we act as a facilitator and I'll say that on

one of the delta boards that I said on their undertaking a lean six sigma process and so far

they're doing it with respect to the production of agenda materials and they went from 100 and

something step flow chart down to about 25 just because they removed the superfluous steps that

didn't even be there these were the value added steps these are what were legally required and

these are the steps and so just if we can kind of do that I mean what what is the sin the lean six

sigma is define along here I have it pulled up it is a define measure analyze improve and control

and so you know just to map it out flow chart it what it takes from somebody to go from idea to

building and it would probably astonish all of us so if we can figure out how to get out of our own

way then that certainly makes those goals of providing more housing for everybody a little bit cheaper

a little bit faster and a little bit easier thank you thank you surprise hume surprise Rodriguez

supervisor hume I am a big big supporter of lean six sigma kaison or any of those process improvements

I think that any process that we have that has the potential to have pain points or obstacles when

you utilize lean in that format it's amazing what can be identified and I've been a strong you

know proponent of utilizing lean even for homelessness in general like just be able to identify so

many of their barriers and the pain points within the process of when somebody is homeless and

you know what are those barriers is it housing is it you know access to mental health you know

mental health care or or addiction recovery so I am such a supporter and I'm really pleased to hear

that that you've made that recommendation because it is it is the way to go when you want to make

improvements to any kind of process thank you thank you all right any further comments questions from

what members see nine random clerk any others kind of speak on the matter there are no okay so

we do have recommendation from us at this point entertain a motion

chair will move is there a second second it's been moving second please vote

yeah then passes unanimously very good thank you excited please

I don't number 34 is to approve this Sacramento County Good Neighbor policy for shelter

and housing programs serving people experiencing homelessness good morning Shabongatari deputy

county executive social services and I'm presenting today because the policy that I'm presenting

really overlap several of my departments but I do have my department heads here to answer questions

should something specific come up so last October the staff from the Department of Health Care

Services presented on the grow flow and behavioral health housing project at that time the board

of supervisors expressed as desire to receive and approve a good neighbor policy and as a reminder

our existing safe stay communities and shelters do have good neighbor policies that the board

helped to inform as we brought those projects forward for approval at that time in October staff

recommended developing a county wide set of minimum standards standard practices to serve as

good neighbor policy guidelines for shelters and housing programs serving people experiencing

homelessness this is to avoid the inconsistencies across our various programs so if approved today this

policy would apply not only to the Grove Florin behavioral health bridge housing project but it

will be aligned with the counties more generalized good neighbor policies for all of our county office

buildings and and other centers so in order to create this policy staff from several of our

health and human service departments collaboratively reviewed existing policies that have been applied

to various program types and agreed upon a baseline set of standards for county funded homeless

service programs the good neighbor policy addresses several key areas setting minimum standard

practices including but not limited to sufficient parking waiting areas and restrooms so as to not

disrupt the surrounding communities maintenance and cleanliness standards including debris removal

graffiti removal and landscaping managing crowds and anyone who's lorterine in the area surrounding

these programs and keeping good community relationships with neighboring residents and businesses

including addressing community concerns proactively and assisting in crime prevention based on

specific needs of each of these communities there could be additions or addendums to this policy

that can be added into our contracts with the providers in those neighborhoods so our recommendation

is to adopt the attached resolution to approve the Sacramento County good neighbor policy

for shelter and housing programs serving people experiencing homelessness to authorize the directors

of the department of homeless services and housing human assistance health services and child

family and adult services to amend existing homeless service contracts to ensure compliance with

the approved policy and then upon approval staff will review and update these contracts across the

departments according to the minimum standards and will collaborate with the affected programs to

ensure compliance and to ensure community engagement when implementing the policy at each site

so with that like I like I said the department heads are here to answer questions I'm also

available for questions thank you shavon we do have uh supervisors in the queue we will start with

supervisor Kennedy thank you chair uh shavon so just to make it clear you said that this is

basically a baseline but we're going to have to individualize each one as it comes on because each

of these as we have found with our experience has different circumstances depending on where it is

and how it's operating all that absolutely and community engagement is really a good example of

that where certain communities are going to want more of a voice in every community we want to

always have a county touchdown like somebody who they can call if they're having problems but

some communities may want to counsel like in the case of uh florin and power in and other communities

may just want a contact information so we'll have to develop that as we go thank you i appreciate

that I think flexibility is important it's nice to have consistency and expectations but we have to

be flexible because they are all different um the other question so who is this who will this be

between is this between is this part of our measures when we adopt and and a project like this so

therefore the operator signs on to it is it between the and then I guess the most important part is

we're seeing in some areas is um who enforces right right no it's a good question so these policies

will be applied to our operators as well as some of our county operated buildings um and they'll

be contractually obligated to follow these policies enforcement's an interesting question because I

think it really depends on what it is and where the location is so we know for instance in if one of

our locations was in a city jurisdiction it really would be up to city code enforcement law

enforcement whatever um the entity was to um to enforce that and we will work closely with those

jurisdictions in the county we may need support with law enforcement and in in some cases with

the sheriff's department and in some cases it might just be a matter of contractual compliance us

holding the operator to that that last part is extremely important because um there's sometimes

a hesitant some the part of the operator to uh they want to they want to have these as low barriers

possible and we all agree that there's different heights of the barriers depending on the location

but we have to hold our our contractors and the people who are operating there on a 24-hour

basis accountable to make sure that these measures are put into effect absolutely it has to be a

balance like you said there's no way our programs will be successful if we don't have the community

support for these programs and we can't get that if we're not holding ourselves accountable

thank you very much thank you supervisor Desmond thank you mr. chair and I first really appreciate

this coming to the board for a discussion i think this is extremely important and and supervisor

Kennedy hidden on hit on several of things i was going to bring up as well i think that's really

important that you brought out the issue relating to whether uh a shelter is in the city or county

and what the kind of relationship and what the complexities are with with shelters that maybe in the

county but border the city because like like you mentioned the county does not have control over

code enforcement or trash pickup or law enforcement in those city areas and so i know we have a

representative from the city of Sacramento here today that'll be talking on the next item um

but are do you know if the city of Sacramento has a kind of a general good neighbor policy like

this at all shaman i believe they do i'm going to look to Brian yeah okay he's shaking his head

and Brian's going to be available during the next presentation to talk about the city but if you

want him to come up he can i will say we work very closely with the city of Sacramento um and our

other city partners on these issues we meet with our city partners weekly to talk about these

issues as they come up but it is complex to your point would you like Brian to come up no wait

till the next item ask a few questions about that no Brian it's always great to see you thank for

being here i think it's i think it's a good policy i think we as supervisor kennedy mentioned

it can be tailored to the unique situation of the different shelters but i also think as you said

i want to underscore the importance in terms of just the the the community involvement in having

one of these and the the amount of engagement which will which will vary depending on where it is

and i know supervisor kennedy supervisor sir and i've already done a lot in terms of that

community outreach and the shelters in their respective districts and we will be doing a lot of

that i've already done a lot of that pre-construction with the safe state community that's going to be

coming online and on what avenue i think this this instills a lot of confidence in the community

that we have something that that's formalized like this so i just appreciate your work and i think

it also dovetails with you know right now there's legislative efforts to impose additional scrutiny

on shelters more from the perspective of course the residents and those shelters themselves but

i think there are some elements of us having a formalized policy that kind of dovetails with some

of those legislative efforts to have more scrutiny and make sure our our shelters across the board

meet certain requirements not not a barrier to participation or enrollment certainly but with

an understanding that there has to be certain minimum rules and standards that need to be followed

if you're going to be taking advantage of one of the shelters so thank you shavon

supervisor rhodrika thank you thank you shavon um one up i just want to share one of the conversations

i had with um david and shavon and it was around the community relations and the um word engage

and how engage is a very um subjective word when it comes to how providers will be engaging with

community but i think that we touched on that some of them are different and that it will it will be

part cater to the how that particular shelter is and then the other thing is you know it may not

it may be beneficial to have uh to see how the city's Sacramento has their

Paul a good neighbor policy in comparison to the county and see what we could do to

um you know sort of have an identical process that has an expectation of how our shelters will

operate their business thank you yeah i appreciate that we in fact we just had a discussion yesterday

with our city partners about just the need for more consistency across the system and so

some of what will be coming to the board and upcoming months will be talking about ways that we

can become more consistent thank you great thank you other comments questions from board members

see none and clerk do we have members of the public center to speak on this matter we do not

all right very good drum happy to uh move approval of the good neighbor policy

i'll second okay it's been moving second and please vote

that item passes unanimously great thank you next item please

i have a number 35 is this semi annual homelessness report good morning and at the clerk could pull

up the PowerPoint um good morning chair sernah members the board and m mle how can the director

of your department of homeless services and housing um and while i'm going to be giving the

presentation today i do want to acknowledge that this is i come every every six months oftentimes

more times in between to give you a high level update of the work that's coming out of my department

and in partnership with our sister departments as well as the city of sacramino and others and so

i just want to acknowledge that um all of my staff contribute to this but a couple in particular

Rachel Davidson is here in chambers with us she oversees all of our outreach efforts and does a

tremendous job and while he's not in chambers today i want to acknowledge Andrew Gurkink he's

very behind the scenes he's doing all the data pulling maintaining our dashboards and really

um providing the information that i'm able to give to you to to be as accountable as possible

really quick Emily chair sernah do you want us to ask questions as the slides come up or

why would we break from tradition now i would as the slides come up yes okay that that's my

preference thank you okay great um so um as i said this is uh what we uh call our

biannual update um on our the county specific efforts to address homelessness this report typically

does follow as it does today the city county partnership agreement that goes to the city council

and it was there just a few weeks ago um but this report focuses mostly on similar efforts that

we're doing in the unincorporated component parts of the of the county and so the partnership

agreement report is attached to your board letters attachment to um i'm not going to go through all

of the deliverables of the partnership agreement but i do want to draw your attention if you flip

through it you will see that we're very happy to report that all of the objectives have been met

the partnership agreement has been a great cornerstone for us as partners to to work together and

to change systems and so it's really been we're proud to say that we've delivered everything we

committed to and continuing to work very very closely um with the city so while i'm not going to

delve into the data specific in the city as uh shavon said brian pedro um who's the director of

the department of community response is here today and is available to answer any questions you

might have about efforts specific to the city of sacrameno and then additionally my colleagues

from the department of health services are going to follow up with some um information on our

behavioral health outreach uh partnership that happens not only in the county but also in the city

and then finally shavon alluded this as well but today's workshop is um very focused narrowly on

county led efforts but we recognize that our efforts are only as good as the bigger system of care

and that includes efforts of the city sacrameno steps forward our local community based

organizations and so we are planning with all of those entities a broader system wide uh conversation

i'm hopeful it'd be had with you as well as the city council coming up later this spring

so with that um we start with outreach i'm going to talk a little bit about sheltering

um out um efforts and then hand over to sherry to walk you through behavioral health efforts

so as a reminder here in the county we are very uh committed to having outreach teams that

are case carrying and that really means that our outreach staff are working directly with clients

and maintaining that relationship hopefully until the point that the people leave unsheltered

homelessness the services that they provide on the streets um include such things as case

management housing search assistance um vital document retrieval transportation support

and behavioral health referrals and we think this is a really critical component to successfully

using our outreach folks to connect people and exit them permanently from uh homelessness

the county currently contracts with community health works or cohe wo as we like to call them um who

are also here today in the audience we have Ryan Tiffany and Jamie who are all directly working on

the ground with folks experiencing homelessness in the parkway as well as the unincorporated county

and if the board would like they're available to share some of the outcomes they're seeing related to

engagement with uh cal aim services as well as some of the more um one-on-one interactions they're

having with people living unsheltered here in the county the cohe wo team currently includes 22

community health workers or navigators um who co-deploy with our four clinicians and peer

specialists with behavioral health and Sherry's gonna talk more about uh those team members

this slide just shows a snapshot of some of the demographics of the folks excuse me and we

sorry we have a question or comment from supervisor Rodriguez. Sure and on page um to the proactive

outreach to county identify priority camps what would define a priority camp? Sure yeah

so that could be something like we've had the case where the department of transportation has a

roadway improvement project and there's an encampment along the right of way and so we need to get

people out of the way for safety it could be a report that comes through the sheriff's office or

the rangers office or yours offices of a growing encampment um with with debris it really is um our

ability to proactively get out to wherever we need to be um the definitions are loose um but we try

to to provide resources um to meet the needs of our other county departments thank you yeah

so these demographics show a snapshot as I said of the folks who were enrolled in our outreach

program that means actively enrolled in working with cohe wo during the last six months of last

calendar year um these demographics are pretty consistent um with previous reports and they also

very much align with who we see in system wide reports such as the point and time count but also

some system dashboards and reporting that Sacramento steps forward maintains uh most importantly is

showing the impact of our outreach efforts and we're we're very proud of this and really happy to

have the partnership of cohe wo um you can see in the last six months of last year our county funded

outreach teams provided over 25,000 individual services to 810 unduplicated individuals

Emily sorry yes sir vice-regime thank you chair um I just wanted some clarification because it's a

question I had as far as the numbers of individuals serve so on that slide and in the report it

references 810 unduplicated individuals and then later when we talk about shelter performance

enrollment that figure goes up to talks about households but then 1358 distinct individuals

and then uh when it gets to the BHS data summary it says 1300 and 60 unhoused residents were

referred to county and so I'm just a little confused because the numbers don't align definitely

understand and and apologize for that so the 810 is the people who during the six months of

last year were enrolled in outreach services mean they were living unsheltered at eight point in

time during that six months the second number you referred to are people who were enrolled in our

shelter programs some of them could be the same people but many of them could not be and that does

reflect um the capacity of our shelters and then the third number the behavioral health I believe

in all that Sherry confirmed um is is touching on the broader um swath of folks throughout the

county not just unincorporated I see and that was and thank you for that because that's a lead

into my next question is are these numbers unincorporated county or they county as a geographic area

so you think that so these numbers on this slide right now the 810 are unincorporated or parkway

so the people in our outreach program are all living within county controlled land the shelters

because we have coordinated access and so we don't um necessarily only we don't stop the line

and who can access a shelter um it could be it could and does include folks from throughout the

county including many of the cities um and then the behavioral health as I said they don't really

they work across jurisdictions as well so okay completely understandable why it is confusing

and I apologize for that that's very helpful information thank you great supervisor Rodriguez

and so Emily just to clarify this is the 14% of the overall correct so this is the 14% that is

unincorporated Sacramento County I think you're referring to the point in time count which was about

14% of the point in time count was in the unincorporated county okay so this I believe um this is

a different count but yet if you were to try to match it up to the point in time count this would match

loosely how the point in time count delineates by geography um the point in time count

doesn't look at the parkway distinguishable from the parts of the county it runs through so it's

not as exact but it's as that's as analogous as you could get within the point in time count

that and I should say 810 people is unlikely the total count of people experiencing homelessness

in the unincorporated county for the last six months it is the count of people who engaged with

our outreach teams and we're willing to enroll and outreach services but of those

810 people you can see the um the level of services provided and over 25,000 services which equates

to approximately 31 services per participant those can happen over multiple visits those can

happen in one visit it really is client driven and most um most important to us and really

something we're extremely proud of is it these teams were able to support 184 people during those

six months to move out of unsheltered homelessness either into temporary or permanent housing so

this could be facilitating movements into shelter into a treatment program but it also includes

folks who left um directly from unsheltered homelessness into permanent housing um there were

67 of those of that category moving into the shelter programs unless folks want to ask more about

I do outreach I do have a question oh okay sorry oh it's fine uh quick question do we know the

average cost per person for outreach um I don't off the top of my head but we can fall okay we definitely

um I mean I I know how much the contract is and you can do a loose uh what I think is more important

we've been asked this before and so I can endeavor to do a little bit more deep diving not just

for you but for the other supervisors is the cost of um providing these services versus the cost

of not and there's lots of national studies that show the extreme sort of cost to the society

of folks living unsheltered that includes the cost to law enforcement that includes a cost of

health care um we don't have it specific here to Sacramento but I can do a little bit more work and

provides some of the um researches out there um related to that if it's helpful thank you that would

be great yeah okay so moving over to the county funded shelter programs and just because this

is asked before this is not gonna um necessarily relate to people who were unsheltered in the county

and or in the unincorporated county and now are in our shelters these are shelters that are

operated and funded out of my department and as a matter of fact many of these shelters are not

in the unincorporated county physically they're in the city of Sacramento or in one case the city

of Rancho Cordova um we this data is primarily coming from the dashboards which I've shared with

all of you and we talked about the last time I was here at the biennial up or date all of this

data comes from HMIS the homeless management information system um and we do update that dashboard

monthly to give you a snapshot so I'm gonna share just some highlights uh today Emily yes

survivor Rodriguez um Emily how are we measuring outcomes for these particular shelters

yeah that's great question so the primary um thing that we look at is efficacy of moving people

out of shelter into a permanent housing that's our number one priority and you'll see later um some

of the data on that as a system we have a shared goal of exiting 42% of folks from homelessness

and department housing across the system um some of our shelters are meeting that some are not

we're working to improve those that are not other things that we commonly look at though include

lengths of stay ideally people would stay for the shortest amount of time necessary to move them

into permanent housing and we also look toward uh a negative exits people who are returning back

to the streets um and why those reasons are and what can we do to minimize those those negative exits

um we also just look generally at demographics and are we trending in line with what we know about

the homeless population in general are we seeing disparities are we seeing demographics that are

prompting us to change our response so for example as we see the aging of the homeless population

it triggers us to think what additional services do we need to bring to meet the needs of these folks

that we're now seeing come into our shelters we didn't before thank you everyone more question

yeah of course how do we value how do we validate our shelters are performing according to the

scope of work yeah that's a great question so um we hold an out of my department and the my

sister departments have a few of these as well we hold the contracts and we do do contract monitoring

I have teams of planners who are weekly doing case conferencing with our shelters to make sure

that the very individual level client issues are resolved client exits are successful um and then

we do financial and and program monitoring on an annual basis um it's a little bit challenging we

have shelters in our community some of our newer shelters which have been resourced really well

those new safe stays um and have a plethora of resources available to them and we have shelters

in our community who've been around for many many many years and may not be resourced the same

so it's a little bit um apples and oranges and we're working really hard to lift up so that all of

our shelters aren't even playing even playing field so that then we can be a little bit more um

prescriptive about outcomes that makes sense you know something as you were speaking earlier is

when we have our different shelters and some are performing better than others you know and I

they are they are competition to each other but at the end of the day best practices or something

that um would be great to extract and then share that overall with with these providers

I agree I think that's fair and and you will see differences not just um it's surprising

facility differences can make a difference so some of our shelters have very large common rooms

where it's easy to have gatherings in case mentioned some are you know kind of uh don't have

those facility improvements um some are serving uh you know populations that include children

as those different needs um so um but you are correct there are best practices and um our

our shelter providers and community providers in general I think should and can be good resources

to each other to lift up thank you thank you um so just these are the um eight I believe shelters

that are gonna that are included in the data I'm going to show you now um we are working to pull

in additional shelter programs including some that are not directly operated on my department

you'll see on here because this is last year it doesn't include for example the stocked in safe

state it hadn't opened at the time the data was pulled um and we're continually adding new programs

as as they come on board so again um the demographics this looks um pretty similar to what we saw

in regards to the outreach program you'll see um this sort of same breakdown between

genders and race the one thing I did want to lift up here is the age bracket here has a pretty

broad range of 45 to 64 but we did dive in to uh look at the number of folks who are being served

in our shelters who are 55 or older is sort of a demarcation and that is 30 percent so in the last

six months of last year 30 percent of guests in our county funded shelters were age 55 and older

and keep in mind that we do have two family shelters which by definition have minor children with

them so that's throwing off the average if you took those children out we'd we'd see a much higher

average and this is one of those data points that we try to monitor and is concerning to us because

the needs of folks as a advance in age um becomes becomes more challenging excuse me Emily yeah

survives the Rodriguez yeah you mentioned that 30 percent over 55 that is definitely I agree with

you it's a very concerning population because as you age and you are you know um you're in a

shelter it makes it very difficult at that point even to you know survive long term is there a

plan to address the 30 percent aging homeless population that is a great question I would actually

surmise that the the population is is more than just the folks in our shelters so one of the um a

program that we all committed to during the regionally coordinated homelessness action plan or

arch app which the board adopted last fall um as did the city council was commit a study on the

needs for folks as they age um not just um health care issues but we have people who can't take care

of their activities for daily living or ADLs they have mobility issues some of our facilities are

not built to that we the county has engaged a consultant in about the past month and she's doing

assessments of the existing shelter program and she's going to bring some recommendations to us

as a system that could include things like how to adapt um existing shelters to bring in more

extensive health care services or um physical improvements or other services that just are lacking

in our system overall so we just engaged her I think the contract started about three or four

weeks ago yeah I think for long term you know the we have the baby boomers that are that are

already in this age population and baby boomers are they're huge and so when you look at

the potential long term and we start looking at preventative measures this population is going to be

one that we're going to have to keep on eye on and and ensure that we find the um you know

that resources to be able to ensure that aging people are able to be in a shelter if they

fall into homelessness thank you yeah and and maybe for our bigger system workshop and I'm looking

at Trent here who really is the holder of the sort of system wide data I've heard many folks

including Trent and others who are experts in the demographics talk about the sort of folks who

are experiencing homelessness of aged wild homeless versus folks entering homelessness for the

first time at an advanced age and we're seeing both of those trends and it's a very different

response needed and so perhaps as we plan for that workshop we can do a little more deep dives

into some of those demographic trends system wide because again this is a snapshot of eight shelters

but I totally agree with you it's it's definitely something we are seeing and really

challenged to provide appropriate services for just really quick I want to say you know this is

in reference to the presentation prior to this where it showed that the regional needs housing

assessment we have you know I mean it out of the 4,000 we only create at 75 and that very low

so as we have this aging population that may be on social security or some you know some form

of government you know some form of assistance the funding is really small so it's that that very

low housing is going to be really key to ensuring that we can get some of the aging population into

housing thank you yes and there was a great preview for my next slide um there's lots of data

points we could pull out but we pulled out a few others which I think underscore the the point

you're making super reservoir Rodriguez again looking at the same population of folks who were in our

shelters in the last six months some of the challenges which I think will resonate with you about

why it's difficult for folks and think about the Mike Jasky's point to move out of shelters into

affordable housing 64% of the folks and self reported to disabling condition this could be anything

from a mental health issue to a physical issue to a chronic health disease but that's that's

pretty significant and the amount of co-occurring disorders that we see in the population is is

pretty high as well speaking to what you just said super reservoir Rodriguez 40% at entry into

the shelter system as a whole have zero income I haven't done the cut here but I could to see how

the next band is probably people living off of social security which is not enough to afford an

apartment on your own and then sort of speaking to what I just said about aging while you're homeless

the average length of time that a person had experienced homelessness before entering our shelter

system was almost four years so what this tells me is we are doing what we committed to doing

which is targeting the most vulnerable folks living outside but this also is going to exacerbate

lengths of stay and make it much more difficult to folks to moving out because the preponderance of

these issues are just really challenging. Supervisor Kenny thank you chair just to follow up and

to get clarification on what you said about the 40% self reported no income and then you said there's

a stratus that had that's on that's on social security I got it why is 40% so high why I this is

my ignorance here so this is not a loaded question why it seems like a you know vast majority of

these folks would qualify for social security so when we when we're meeting with them when we're

particularly when we bring them into the shelters we're getting them signed up to social security

where we can right yes yes so this is that entry and so I agree with you this is not about

eligibility this is about actually accessing benefits but you are correct is that most folks here

should be and are eligible you'll you'll say the same trend where folks enter into different

programs and are not connected with health care despite we have an affordable care act which most

people should be eligible for and so this is one of the first things we do sign up for benefits

but this just means they've probably been living outside for years and years and not taking advantage

entry I thank you thank you thank you chair so I had a couple of questions on these numbers as

they related to some of the graphs later in the report so my first question is relative to the

disabling conditions two of the bar charts are mental health and substance use disorder and then

there's also developmental and I don't know what that developmental piece is developmental disability

would be stuff like autism ADHD those types of conditions okay so it's it's a I guess a debilitating

condition that is not necessarily mental health and keep in mind this is all self reported so it's

going to be very different than what behavioral health is going to provide you with a clinical

assessment and that was my second question is I would imagine for a couple of these to be self

reported one requires an awareness and also requires a kind of a you know an admission on the in

part of the individual I would assume that the actual rate might be higher than what self reported

yeah I think that maybe when I asked is it when Sherry comes up as she can sort of talk about that

that clinical because I think that you're right is probably a knowledge gap of like what's what

is going on isn't going there's an awareness and there's also a willingness to share at the

point of entry into a new place one of the great things about having our behavioral health partners

there is that they can do the more time spent getting trust built and also do that clinical assessment

of what's what's actually occurring here you're probably correct is that on both ends people are

either over reporting things that actually don't exist and or under reporting I think that's a fair

assessment yeah okay yeah and then my next question is about the length of time you mentioned

previously about there being both instances of people aging within homelessness to represent an

older population but also coming into homelessness at an older age you know I've said many times

before and this isn't comes no surprise I'm not a fan of housing first and one of the reasons

because it focuses on the most vulnerable first which in many cases are also the hardest to cycle

back out of homelessness whereas I would have a different definition of vulnerable to say that those

who have just entered homelessness are the most vulnerable to getting sort of into the deeper hole

that now becomes harder to pull them back out and so is it a safe assumption to say that the

longer somebody spends in homelessness the harder harder it is to to help get them back out of

that their situation I think it's definitely a safe assumption to make I also completely agree with

you that the more we can prevent folks from entering homelessness and becoming the next person

who's been on the streets for four years and so just as we ratchet up our crisis interventions and

our shelter interventions we need to simultaneously working at the other end on preventative measures

because those folks who are on the lower vulnerability scale and just fall out of homelessness

actually a shelter is not an appropriate place for them what's more appropriate is let's help pay

your rent and get you back connected with mom or dad or stay out of homelessness and so

we can again at our bigger conversation I focus on some of those upstream measures that we're

making we're not doing enough and I think I don't want to spoil the message from SISF but when you

look at data you know where we long-term would make more impact as if we had more prevention up front

and more affordable housing at the back end but we're in such a crisis moment of people literally

dying on the streets that we're sort of faced with this challenge of how do you balance those things

and so what if we even weren't to you know recognize the the task of getting all the way up stream

and focus on falling into the river like just that moment when it happens to get it corrected

out quickly right so in our world we call that diversion so prevention is a little further upstream

diversion means I'm knocking on the door the shelter and I want to stay there tonight how do I

keep you out of the shelter we don't I would say that is an effort that SISF is leading on our

behalf we have some other community partners doing some of that work it's really hard to tell that

tipping point of like but for this help you're going to be on the streets but those are a much

cheaper interventions right and often much more effective than they so I agree with you and

we do have some of those resources as people knock on the door and we we don't have enough as

clearly as evidence by sort of the broader system inflow because even as we're moving people out

people are still falling in yeah yeah thank you yeah yeah Emily yes how deep a dive is there on the

self reported disabling condition front in other words do we know if someone is an experiencing

substance use disorder what their particular disorder is alcoholism is it meth is it opioid addiction

we do not know that level of detail but what I do have and I do have it because I thought somebody

might ask this is amongst those disabling conditions how many self report mental health versus substance

use disorder but I don't have the data on which substance for example and on the behavioral health

or the mental health issues again I would probably look more towards once they're enrolled in behavioral

services that clinical level of insight into what the actual diagnosis is but I am happy to share

if you want the so you don't you don't have the data but does it exist it does I do not believe

that the type of substance exists in HMIS no so I'm right the type of substance does not exist in HMIS

where I'm pulling this from I don't know if behavioral health once you're enrolled in that level

of service would have that level of detail and I think I'm seeing Sherry say yes we would we do

for the for folks enrolled in behavior and county behavioral health that is a

set of statistics that I would be very interested in understanding a little bit better in terms of

which disorders dependency disorders are relevant to how they report their disability

so I can I can tell you breaking apart this data and it's not going to add up correctly because

people can self-reportment many disabilities but 35% of the folks in our shelters in this time

frame self-reported substance use disorder as one or more of their disabling conditions and

similar to a raw politicians appear so we look at polls on occasion but can you get can we get

crosstabs on like understanding demographic information relative to the types of disorders

that kind of thing in gender as well I mean we could definitely do demographic cuts probably not

the not within HMIS the types of disorder but for example yes my staff are working with

Trenton his staff could look at gender and age differentiation between self-reporting

substance use disorder versus chronic health conditions we absolutely can do that so vice-erad

so a couple of weeks ago I asked for a report on deaths for the past five years in Sacramento

County which I found to be incredibly enlightening on and I don't know what the correlation is of

deaths to individuals who died on the street and it showed the cause and so fentanyl poisoning was

a very profound you found these seen in many of these deaths and so it'll be interesting to

look at the cause of deaths and versus some of this data that we're talking about right now

which I don't know but it seems like there may be a relevance on because it even

showed some of them on alcohol poisoning suicides is so on yeah and we have to have a few

initial conversations that data you're referring to comes from the corner which is obviously

separately held here about doing some cross tabulations we would need identifying information

because the folks that she's dealing with may or may not be in our system right they could have

died on the streets unknown to us but I do I do appreciate that and so how can we as a system

of care while we have them before before they their death potentially intervene I'm happy to talk

more with her about it is an interesting tool but it's not as easy to sort of cross tab with our

database oh sorry no that's okay so just another item to lift about again our county funded

shelters is shelter utilization something that we're very keen on making sure we don't have empty

beds if at all we can avoid it and you can see that from July to December of last year

we this is the number the supervisor Hume reference earlier we served about 1300 individuals

in about 1100 households households could be inclusive of children or not and you can see that

on average our utilization rate hovers around 90 percent we track this on a monthly basis utilization

can can go up or down based on facility issues sometimes we have to stop enrollment because we

have some fill-tility issues certainly as new shelters come on board it takes time to ramp up

but most of our shelters all but all about two of them are within the coordinated access system

which is helping us to improve utilization so there's not sort of a you have to know which door to

knock on and and so we're really happy to be working with Sacramento subs forward so that we can

prove efficacy countywide system wide to make sure that every bed that's available is filled

as quickly as possible supervisor Rodriguez so I you gave me a report of all the locations

all the shelters and I think that report that you gave me had all of them those in the county

and those within the city or I guess every location I yes I think what I you're talking about I gave

you a version of what's called the housing inventory count or Hick which our continuum of

care is required to do annually to report to HUD homeless programs and so I had separated out by

both who funds it and then the geography of it so it was inclusive of every shelter program that

we know of that is either privately or publicly funded in the county of Sacramento and so when I

looked at this particular report I looked at there's about a 10 percent you know somewhere between 10

and 15 percent vacancy and so what are the barriers to achieving a hundred percent utilization rate

by every shelter so yeah so I just want to clarify this 90 percent is only of the eight county

funded shelters the publisher but the question still stands some of it is just turnover and how

quickly it takes to find somebody get them transported there get them dock ready or whatever documents

they might need for the shelter some of it is certain shelters have certain priorities that take

a little bit longer so for example some shelters can serve folks with their pets in some can't and so

if you're on a way some shelters have requirements to do a little bit more vetting and background checks

and so which can just delay the time sometimes it's just natural like one of the restrooms is down so

we got to close the beds but it is a shared goal I think system wide of making that utilization shrink

to much closer to 100 percent we're probably never going to be 100 percent right because if I move

out today it's going to take a day or two for me to turn the bed over and clean it and whatnot but

there's a lot of factors at why and I will say that the this goes to December as we looked as we

looked at January and February we're already seeing higher rates within the county funded shelter so

we're continually watching that doing no how many people were in the queue for that second half of the

year waiting it and I'm going to use the word in 211 because that's where people call I don't know

the exact number but on a weekly basis excepts Ford sends out a list and I'd say on average and

please correct me if I'm wrong the singles wait list tends to hover around 3000 people and the

family wait list tends to hover around 600 families so today like today there are 3000 people waiting

to get into a shelter probably somewhere around there okay thank you supervisor Desmond thank you

Emily this 90 percent utilization rate is that pretty consistent with other large jurisdictions

that operate the level of shut number of shelters that we do I believe it's pretty consistent

throughout our county I don't know if I've looked at other counties you know for example our

family shelters tend to stay fully occupied a little bit easier in some of the singles I have not

looked at other jurisdictions but happy to do that I suspect I suspect it's probably in line based

on the reasons you've articulated and then what percentage of the total 1000s or in our 58 distinct

individuals enrolled what percentage of them were in scattered site shelters um well that's 145 beds

so but they turn over yeah I could get that for you okay I think the utilization and actually

I did provide for David at his request utilization by shelter types I'm happy to share that

with you as well we did February of the first month so we did break it down by the exact shelter

so I can send that to you and then follow up something supervisor Rodriguez just just brought up

which I know I've had a lot of discussions with both cohewostap and and and your office and I think

others is you know 3600 or so people on the list right now waiting to get into a shelter do we

have a sense just based on experience out of that 3600 if we were to offer them a shelter bed today

what percentage of them would accept it and go into the shelter do you have a sense of that

just anecdotally based on on what we see um I will give it my shot and maybe ask the cohewost folks

were much closer to on the ground to weigh in um I think that where we see success is when we can

offer a shelter bed that's available today that meets the needs and desires that person that

often means it's non-congregate it often means they can come with their pets or their possessions and so

it often means it's in the community where they feel at home and and feel safe um when we

sometimes it's challenging for folks to I don't want to put an air quiz but accept

a placement on a wait list that they may or may not feel is going to translate into an actual

shelter bed so it's a little bit challenging to to discern where the where the barrier is is

it that why would I put myself on this wait list with 3,000 other people and never get off

is that a statement of desire to be shelter is that a statement of frustration that makes sense

okay no that's helpful and and cohewost staff who are day-to-day working with people might have

more anecdotal um information to share about um some of the experiences people have shared with

them and I yeah I imagine the longer they're on the wait list the less likely when it does come up

they'll get in because their circumstances may have changed dramatically or we may have lost touch

with them and I know that happens anecdotal a lot but yeah the bottom line is we need to be able to

strike while the iron's hot so to speak and have a range of different I think shelter opportunities

for people yes I mean one anecdotal evidence is that we see when we open our weather respite out

at the wettics the wernyth or youth center the wettic center um it fills up because it's immediately

available you can just walk up to it right it fills up and it's also pouring rain and it's horrible

weather right but it does fill up almost immediately and stays full until the weather changes

but to add complexity by that same token I guess is there's probably a lot of people on what

wait lists of 3 600 people they may be on a wait list but they they very difficult to get some people

even to accept shelter at all even though they may be on a waiting list that is definitely yes

there's lots and lots of variation supervise the Rodriguez Emily is it fair to say that

if they have there are about 6 600 people according to the pick out I believe it's higher but

and there are 3,000 p those 3,000 are people who have said yes I want to get into shelter and

I'm waiting because they actually made the intent to call 211 is that correct or they did an

assessment with their outreach workers yes so they are people who have raised their hand and said

I want so if you look at the numbers it's a little under 50% of people that will

accept the house that are interested in housing I would caution because the point the 6,000

number in the point in time count includes 40 or 50% of folks who were sheltered at the point in

time count so the 6,000 people in the point in time count includes and I can't remember the

proportion but I think it was about 70 30 last time so a good number of those folks in the point

in time count were in a shelter bed so you said 30% of those were in a shelter I believe the

breakdown was 30 70 or 40 60 I'm trying to remember yeah thank you thank you so finally for me

on shelter outcome supervisor Rodrigues asked earlier what do we look for in terms of performance

and definitely the most important thing for us is that you're exiting into a permanent destination

and as quickly as possible so these are those two data points shared with you and for most we do

you know we obviously prioritize folks exiting into a permanent housing solution I did share

that is a system we're aiming for 42% but we also are very supportive of exits that may be temporary

but appropriate for that person so that could be an exit into another shelter into a more intensive

transitional program into a treatment program and so you can see that during the period of time

in question for the county shelters that we're talking about here we had 52% of folks who exited

did go to a what we call a positive exit they did not return back to the streets and 32% of

those who exited actually exited into permanent housing and then the other challenge here is that

this speaks to turnover is that he it's taking a lot longer for folks to leave it's it's both because

the housing market is tight but also the preponderance of issues that that we're seeing people enter into

the shelter and so you can see the average length of stay well you can't see the average length of

stay is 167 days and you do see a difference in lengths of stay when you look at the positive

exiters and the negative exiters and as you would surmise those who have negative exits have much

shorter stays and those who have positive exit state a much much longer time and so we see the

benefit in that but it does clog the system up a little bit more before we get to supervisor Rodriguez

to that last point Emily do we is there an exit standard exit interview or survey do we know

why someone has a brief stay in a shelter is it is because of their dependency on

something what is it typically right so in hm is there is an expectation you collect data at

program exit which includes why the person is being exited we can't force people to share data

so it's not perfect but I can say that I think that I did look at this that about half of the

negative exits were because of noncompliance with program roles which is a pretty broad category

and I do want to emphasize that in all of our shelters unless it's something egregious like

violence against somebody on site or a staff person you're given multiple chances to comply with

program roles but at some point in order to maintain the balance of the community's success we

have to exit folks so that is the most common reason we see and we are working with providers to be

a little bit more nuanced about capturing what's behind the story because that doesn't really tell

you a lot that I will say the hm is data categories are pretty prescriptive we don't get a lot of

leeway there but again that's my earlier line of questioning the data does exist the data does

exist in hm is but it might not tell the entire story but it's definitely more than it's better

than nothing correct yeah I would agree with that also what I haven't heard much about is when we have

just broadly in the entire continuum here that is focused on getting people sheltered

what I haven't heard is much about the effort to find them a connection with family so what

happens on that front even if the family may be out of state yeah can you expand on that yeah

certainly so within the shelter programs as well as our outreach programs family connection is a

very positive thing and so I don't I could pull the data and I will do that afterwards and send it

to you we do capture exits to living with family or friends as an exit category and our outreach

workers as well as our shelter providers are are directed to make those connections and to your

point to out of state we do have some resources if there's a verified connection we do not bus people

out but if there's a verified connection that's appropriate and we think can help sustain it we

have and do through either direct program funds that we administer or through our partnership at

DHA they have some what they call return to residency programs we can support moving somebody

to wherever their their family is it does happen potentially not as frequently as we might like

thank you to rise your laundry and we'll lead you these providers have a contract with the

limit of how long a person can stay in the shelter so most of our contracts do not have a hard

limit but what they do say they do require is it with every 90 days you have to with every with

at least every 90 days you have to re verify that you can stay here so what you can't do is just come

stay at the shelter and hang out and just live there you have to actively be participating in your

efforts to exit the shelter whether that means connection to family or friends or getting into

behavioral health resources and so as long as the people at the shelter are making progress and

actively engaging in their own plan whatever that personalized plan looks like they can stay as

long as they want but if they're not actively participating then after 90 days they would be

likely exited I will say that links of stay are dramatically higher than we've seen even five six

seven years ago and I think that's really an indicator of some of the market and demographic

challenges we're seeing okay I have a couple more questions so during this time period there were

1,070 single adults there are 25% or 24% over 241 days 257 people why are there why I think I know

some of the answers but I'm just curious to know maybe I'm missing other reasons why are there

still 257 people in the shelter after that I think that a very extended period of time

so the I think what you're asking and forgive me if this I'm not answering correctly is that this

is a six months snapshot but people will there's people who will stay that full six months and so

at the on December 31st that they were still a resident they can roll over into January but in order

to capture a definitive period time we sort of have to create a rule so I think that the people

that you're looking at are people who are just what we call a stayer they're going they were there

on December 31st they're going to be there in January 1st they're excluded from the data around

exits because they're not exiting they're staying is that help yes and then the second part to that

question is there were 195 that exited exited I think it was to do the shelters is it first and

first out so the longest you've been in the shelter you become a priority to get into housing no

I say everybody's a priority so the expectation for our providers is that you know day one you're

getting settled getting acclimated you know getting to know the shelter staff but by day two or

three you're working on your housing plan the quicker we can get you out successfully we don't

and we provide within our contracts case management resources so that there's a manageable load so

every shelter should have does have case management onsite to carry a reasonable case load so that

they can successfully work with everybody simultaneously so I get that everybody's a priority but there

is 24% over 241 days in the shelter which means it is they're getting close to a year again in the

shelter do they become a priority when the show when housing or permanent supportive housing

becomes available so permanent supportive housing and which is also access to the coordinate access

system vulnerability is is how people are prioritized and length of time homelessness homeless is one

of those factors that would weigh into your being prioritized for certain permanent supportive

housing so yes and around about way but it's not a one for one because folks who are entering

permanent supportive housing may be entering directly from the streets they may not be entering from

a shelter I think that if we were to and we can do this we were dig a little bit deeper into those

stairs of 241 plus you'd probably see some of the more complex um personal issues you'd see that

maybe the um a higher proportion of folks who are elderly or have long bouts of homelessness who

have multiple disabling conditions I will say this is not ideal but this is not unusual um shelters

across the system are seeing much longer lengths of stay than we any of us would like and I imagine

it's attributed to the lack of housing at the next level at the end of the day that is the number

one barrier for us being able to move folks out um you know exacerbated by their own sort of personal

needs and challenges but access to affordable housing is the number one challenge thank you thank you

so with that I'm going to transition to Sherry Green my colleague from behavioral health

services talk about uh their work and then um if you'd like uh community health works coheo I would

be happy to share some of the the work they're doing on the ground and I'm available for questions as well

thanks Sherry all right Sherry you've seen how curious we can be

sorry green division manager behavioral health services I oversee our homeless solutions

and also children's mental services uh so uh looking at the data here for uh there's two different

sections one is for behavioral health referrals for folks experiencing homelessness in general and

then there are those that are just heart referrals uh heart is our homeless engagement and response

team they go out into encampments and they go out into shelters most of the teams are out in the

encampments we only have two people dedicated to the shelters um which I think is important as I

share the data with you and so all other referrals on the left side outside of heart is on the left

and uh we made contact with 1,360 uh unhoused residents that were referred to our behavioral health

services and then 69 almost 70% of those were successfully linked so they get a referral

which means that they've actually had a conversation with a provider of some sort which might be

walk-ins could be our core outreach teams it could be our hospitals both medical hospitals and

our psychiatric hospitals it could be our mental health urgent care clinic uh they will have a

conversation with the client at that time the client says yes I'm ready to enroll if you think

about those uh referral sources the urgent care clinic folks are in crisis hospital folks are

in crisis either medical or psychiatric those are usually when people are hitting rock bottom or

they're having some sort of uh moment where they're feeling motivated to change in their lives

and so they're saying yes three uh 1,360 are saying yes enroll me in some services get me a

referral and then 70% of them show up and start getting those services and then on the right side

is just our heart so we like to start at the top which is a little different these are folks that

we don't know their name they say I'm not interested in talking to you we give them a bottle of water

we give them some hygiene supplies anything to open the door build the rapport uh get face time

with them anything that we can do of those 1,600 342 agreed to be referred into behavioral

services which means they're willing to give us their name they're willing to engage in the

programming of heart to be seen regularly and to be referred into an outpatient um program

and then of those 342 50% of them or 171 showed up to their appointments and began receiving the

services if we break down the uh the referred numbers there on the right the 342 of those

greater sack was 12% but the larger numbers were actually in our partnership agreement our city

teams 37% agreed to be referred to services and then that small shelter team that I talked about

earlier almost 32% of the referrals came from just those two people and we have seen this data

be consistent over time now heart isn't fairly new team but the data has told a very similar

story over the months which is when folks are in a safe place they're then more willing to

engage in the mental health conversations or the substance use conversations so we have more

success getting folks uh to say yes to us and engaging with us and then when uh it comes to actually

showing up 33 almost 33% were from our partnership agreement teams and 34% showed up from our shelter

team uh referrals and uh we do also have what's called community based referrals uh Folsom Police

Department is a big utilizer of our community based referral system which is calling our

warmline uh sending in electronic referrals through our online system sending us e-faxes and then

we'll coordinate directly with those uh referring parties to then engage specifically it's a really

targeted approach using the community based referrals can I uh before you leave the slide here yeah

the uh second bullet down on the right hand box there uh where it says greater sack 43 all

others yes yes which is referring to the referred to BH services number um what is what how do we

interpret that greater so what does that mean greater sack 43 greater sack are the unincorporated

county controlled properties um and then uh then we have our city our community based referrals which

are the faxed ones okay and then we have our shelters so the all others were the ones that I was

breaking down for you verbally but but that so that those all others the 300 the vast majority

those are the just the municipalities within the county uh no not necessarily we have a

sack city which was 30 well that's one that's one here 37 percent 18.4 percent were the community

based referrals and 32 percent were the shelters I guess what I'm sorry I guess what I'm not

understanding is that the term greater sack refers or implies that this is a geographic breakdown so

I don't know what it means is does all others mean the cities within just Sacramento County does it

mean uh jurisdictions outside of the county uh greater sack is a referral generally to our region

yes so I'm trying to understand that yes I apologize I was misunderstanding your question

yeah so the engagement teams the encampment teams are out everywhere in the county and we break them

down by either being in the city or being everywhere else besides sack city so that's the greater sack

and then the all others breaks it down by shelter community based referrals and uh city of sack

okay so maybe the more appropriate than descriptor is a just unincorporated incorporated right

we can we can rename it yeah well that's that's kind of the language we speak here but um

that that's that's what I was finding confusing so the all others is just the city of Sacramento

no all others includes the city our community based referrals and our sheltered teams

okay all right so yeah it's confusing I'm sorry the supervisor so now we'd be happy to break it

I understand what you're asking for and we'll break it down and and when we send information

back out to the board clarifying some other things we'll we'll break it down differently for you

okay thank you okay any more questions there okay um let's see we're

today leave off here uh so moving on to our next slide yes and then we have our full service

partnership programming I think it's worth mentioning that we had 95% utilization of our full

service partnership programming in the last reporting periods from July to December um of those

that were served in our full service partnership which is our highest intensity outpatient system

for mental health uh 76% were housed um and then 11% were living in shelters which includes

shelters are bridge housing behavioral health bridge housing BH BH or hotel motel uh stays that

our providers are paying for and 9% a little over 9% were still experiencing homelessness or

were re entering homelessness it's not uncommon for folks at this very high acuity lower uh functioning

level to be housed or be uh in a shelter and then exit themselves uh without letting anybody know

uh so coming in and out of homelessness or destroying uh a hotel room and being required to exit

and then having to uh also find folks well they'll be referred they'll show up for that first

appointment and then they disappear and then uh our providers are really diligent at actually going

out and walking along the river and walking at the last known location trying to find the clients

they'll also do a below with our heart team to see if our heart team has made contact with with

the client as well and that I think covers my two slides any other questions

thank you oh supervisor Desmond I do have a quick question thank you Sherry for your slides and

are we getting into presentation also from the city or is this going to be it on there oh

we weren't planning on having a presentation but Brian is happy to answer any questions as

this co-he will I may have a question but Sherry before you go so on the FSPs I mean I think these first

full service partnerships have been a game changer obviously for a lot of people and it was a

big topic of discussion in the context of the city county uh partnership agreement and maybe

you can comment on that a little bit shavon but but also can you comment on I mean obviously we're 95%

of our total capacity with these current FSPs slots can you address that? No I'd like to thank you

so I will say that especially during the partnership agreement design we did commit to

adding slots as we need them and so unlike fixed shelter bed capacity where you know it takes time

and and more money to develop those behavioral health can flex up their full service partnerships

as needed so it would take coming back to the board to do that but we we can do that as necessary

okay now I appreciate that because and I wanted to make sure that was that was clear to people

listening today that hey we're up 95% of total capacity we can get more slots as the need

arises and then the other thing Sherry I just think it's it's thank you for your work it's

incredible and and I think it really want to we should underscore uh to folks that our work for

behavioral health is not just limited to county run shelters right I mean it's it's shelters everywhere

they are in the county including those operated by the city of Sacramento because that was also another

that was a big discussion with the city county partnership agreement making sure the county

commits to providing certain not running the shelters per se in the city but committing to these

services that we're providing and in the in the city shelters so I appreciate you highlighting your work

thank you thank you

so that is the end of our presentation as I said Kaui what was here our friend Brian is here

I'm happy to answer any questions but otherwise great thank you Emily so Reservoir Desmond

I have a question for Brian if you don't mind Brian and a comment what

good afternoon Brian Pedro city of Sacramento Department of Community Response Director

as we've mentioned many times Brian you're city of Sacramento officials are welcome and our

chambers here to have these kinds of discussions so well thank you for being here today

I just want to I want you and I've had a couple discussions about the outreach and engagement center

on Auburn Boulevard near Wad Avenue and we had had discussions about this during some of the two by

two discussions in the past as well and I want to thank you for your report to me about I think

some of the the new beds that have been added there are reserved for families can you talk to me

a little bit about just kind of what your efforts are and what your what the plan is going forward

yes so there's been a lot of discussion on the outreach and engagement center though we see

about changing that from a respite site into a families only as you said we did expand the one room

we separated it out for families only so that expanded us another 25 individuals to be able to

accept in there we are looking at converting the whole thing to family only our hurdle on that is

that's our respite center so we're going to have to determine where where we place respite because

we'd be losing respite to change that because it's a 23 hour stay it would be instantaneous when we

decide to make that change okay well I appreciate that and I'm looking at Shivon and Emily I've had

these discussions with you maybe something to consider is once what avenue comes online which will

have a very large capacity for respite if I'm not mistaken that might be an occasion to to re-look at this

definitely happy to just noting that the walk capacity for respite is the same as the capacity

of a wet at right now at 75 beds currently planned but definitely happy to work with the city if that

is a more appropriate use for OEC okay thank you and thank you Brian and the reason again this has

come up in the past and coming up I'm bringing it up again today is because it's it's obviously a

unique location being next to the children receiving home and some of these other issues so and I

think we do have a need for for family specific shelters as well so thank you Brian

you know so revise your Rodriguez well I first want to say to staff thank you very much for the

presentation and for the information I think it has been very helpful to understand the issue of

homelessness just overall I also appreciate this workshop and to be able to just hear some of the

things that have happened the past six months but also you asked for recommendations and ideas

and input and so I want to be able to take this opportunity to share some of what just I feel

about where we are today and this is not to impute any ones working the past it's just as a new

bee I get to look at things sort of on the objective level and I just want to share that

so in the staff report it said homelessness remains one of the most pressing issues

based in the Sacramento region but if you ask most people in Sacramento they're going to tell you

that the number one issue that is impacting our quality of life is homelessness

and just from my observations and also as an experience being on a city council that is in

Sacramento County the system is broken it's fragmented and we work in silos and this means that

every jurisdiction is attempting to figure out homelessness on their own and there's probably no

doubt that there are overlapping processes with that I'm not sure today that we have the best

plan in place for the problem that we are facing we have had the it's been sort of the similar

structure for about 14 years and the problem has gotten worse year after year I believe by now

should be somewhat of a better well oiled machine to be able to tackle the issues that we're

experiencing I'm also not assured that we have the best practices in place for the shelters and

nor do I know how they're performing and the outcomes that are happening with our shelters I'm

such a big believer and this is really I got this from working in the corporate world and working

around you know so with lean is that we cannot manage what we don't measure and so when we

ex when we don't have the data to be able to make better decisions that becomes part of the problem

one of the biggest concerns I have right now is that we don't have a strategy plan for the

prevention of homelessness which means that we're going to continue to see people fall into

homelessness and which is going to have an impact of the current where we currently are

I am really encouraged that there is a plan to do some collaboration with the county partners and

that's the city of Sacramento all the cities within the county and the actual county I'm a believer

that as elected officials we are primarily responsible for giving direction on what is happening long-term

and and really to demand results there are you know what when I pulled that report of those that are

dying in the street we've had a guy if I go and crack like 1200 people that have died in the streets

due to homelessness and so that is something that should be very resounding to all of us I believe

that we need to identify the bottlenecks and the pain points and the process to get people into

shelters and if it's housing then what are we doing about being able to create more housing

for those people that have the greatest needs I'm a big data person and I believe that

data should be driving many of the decisions that we make and so having data that allows us to

make better decisions I think is crucial at this time again I want to say that I'm really encouraged

by the partnerships I've met with Kevin McCarty and some of the other council members and I just had

some really good conversations about the potential to be able to come together and make decisions

in a collaborative way instead of making silos we're in silos we make decisions for our jurisdictions

but we oftentimes don't have the unintended consequences that it has in other areas of the county

and you know I'm going to really support a regional approach to this problem I think that you know

when we look at homelessness there's a lot of I think a lot of really difficult things that we

need to face as elected officials but at the end of the day almost every elected official that I

have followed in the county has mentioned homelessness as one of the issues that is with the top

reason of what is driving them into to run for office so I just want to share that you know I

you know I as a newbie you get to look at things sort of objectively and I think that there is

a lot of work before us I think that this is something that really needs a more constant attention

if it were up to me it would be you know just a bi-weekly meeting and looking at what are some of

the strategies that we want to look at identify and then really make it just really a focal point

just want to share that but again I do want to thank the staff that have worked on it and the

individuals that have worked on this problem for many years in the past but it is a very broken

system and I I'm encouraged about some of the potential coming down the future thank you

supervisor Desmond thank you mr. Chair I may have a little different perspective I think I think

we have made tremendous strides and a lot of improvement and I want to thank staff Shivan

Emily Bryan from the city of Sacramento Sherry Tim or behavioral health folks we've in terms of

coordination dramatic improvement in coordination with the city's coordination with the city

Sacramento which is where the vast majority of the un sheltered population is totally agree we

need more of a countywide approach and I know we're working on that very thing right now

capacity we are improving capacity with our shelter capacity not nearly enough and we know that

which is why we're trying so hard to bring on more shelter capacity and more capacity along the

housing continuum and the behavioral health continuum but I think in all those areas we we have made

a lot of progress and we cannot take our foot off the gas and when it comes to capacity because

you can have all the coordination in the world if you don't have more capacity it's not going to

get you anywhere and then in terms of I think we all realize that there is a a group of unsheltered

who are very difficult to get placed because of their addiction issues because of their behavioral

health issues there are some new tools we have at our disposal Laura's Law Care Accord SB43

implementation which is going to be coming none of those are going to be a silver bullet and at

times that intervention sometimes are asking intervention or at least pressure from law enforcement

and a lot of people don't like to hear that but sometimes that kind of pushes people to take

advantage of something that we're offering them but again we have to have that something in place

to begin with so agree with supervisor Rodriguez on a lot of points in terms of improving our

approach countywide with all the cities not just the city of Sacramento and improving some of

the systems related issues you know I know Lisa thank you for being here Lisa I want to call

out Sacramento steps forward as well for your help I know we've we've all struggled mightily with

improving coordinated access improving 211 improving HMIS that work has to continue because I

think when you see some of the silos and some of the difficult communication issues among the

stakeholders out there that that is a big challenge but it's a inherent challenge I think when

you're bringing together different jurisdictions and different stakeholders in any public policy

issue that you're addressing I like to go out occasionally with the sheriff's hot team and

certainly talk with our our co-hew off folks I'm looking forward to a four hour ride along I have

coming up next week with with Rachel and Emily's shop and and the hot team because I really like to

see okay with some of these challenges we're seeing with with silos and lack of communication show me

what what how that's happening in real time and then I can come back to Emily and Shivon or maybe

you can call them from out there and say hey this is where experience can we fix this right now but

I think that's really important to do that as well so I just want to thank all of you this is a

huge priority for this board it has been for a long time and I think we're we're we have a lot

more work to do but we're certainly heading in a better direction thank you I know supervisor

Kenny's in the queue and certainly one of here is remarks and prep statements on this important

matter but I'm going to take chairs prerogative and jump in here and just say I agree with everything

that supervisor Desmond just said and I appreciate the supervisor reminding us listing for us all

the various angles that we have right now in place and I would just go as far as to say you know I

think when our newest member of the board joined us we knew that there be days where we disagree

and this is one of those days I couldn't disagree more with the statement that it's broken

and maybe that's attributable to as was knowledge newness on the board if you were here

five years ago and looked at this challenge is immense challenge that we have undoubtedly the

greatest hurdle that we have as policymakers and as a local government constrained with finite

resources that it's very different today than it was then and you know I give a great deal of credit

to my colleagues supervisor Desmond who provides your county who have been our representatives engage

with the city of Sacramento working with Emily and others on developing the partnership there

partnership agreement that was a bit of a game changer I would say that is evolving as was

acknowledged today by staff so it's not broken at all and I would again express my pride in being

a small part associated with the fact that this board and our executive team and our partners

outside of the county have gone over and above to think differently do differently try and circumnavigate

the complexities of what in large part is a combination of human nature and behavioral health

and mental health and you know substance use disorder economic challenges lack of housing

so many things contribute to the circumstance of homelessness it's not ever going to be one

agency it's not ever going to be one nonprofit it's it's never going to be one city or one county it's

it's going to have to be a very concerted thoughtful combined effort so I would say please keep doing

what you're doing and of course we all want to make sure we understand to a person that there's

always room for improvement but again we have what we have to work with and I think we we've

appropriately prioritized this and it's reflective in the data that's why you had a lot of questions

from me and others about data and maybe acquiring even in greater detail some of that those numbers

and figures so that we have a better grasp on the nature of our progress and what needs perhaps

more attention but again I'm just very proud of this board and and of our staff and our partners for

really really doing what is necessary to get people out of the circumstance of homelessness

Supervisor Kennedy thank you Sherry appreciate that appreciate your comments appreciate your comments

Supervisor Desmond made my comments my shorter because you covered a lot of ground there and you

were dead on both of you I will say a couple of things and just give you an anecdotal story I

remember about eight years ago seven eight years ago when I was walking precincts and knocking

on doors for another candidate with that candidate who was running for office at the time and and the

neighbors would say you know what about this homelessness and that particular candidate would say

it's going to be it's going to be you know taking care of in the next five years and I would cringe

every time because we knew that that wasn't possible that the problem was far too severe and we

didn't have the tools at hand we have so many more tools as Supervisor Desmond stated now that we

have not had before and we're I now feel unlike I did at that time I don't cringe because I do feel

that we're starting to see results we're going to see results based upon the fact that we do have

tools and we do have processes in place we didn't even have a department of homeless services back

there and so you know we've made tremendous strides so come out with a hashtag it's broken

kind of is infuriating to me because of the great work that is being done and the progress that

we have made and are being made now am I here to say that we're going to declare victory absolutely

not we're nowhere near there but we've got things in place that we've never had before and I think

that we're heading in a direction that we've never had it in before in coordination we've never

seen before whether it's between the city and the county or just within county departments so

you know I I agreed 100 percent I also want to be I'm a little leery when I hear you know

easy things for politicians to say you know I you know data driven decisions of course we want

data and we want data different different different decisions but I'm telling you I'm a little

bit impatient at this point and seeing that we've been collecting a lot of data for 12 years

public's done with data the public wants to see that tent that encampment off of the

inf not in front of their their person place of business anymore to see not see the garbage in

their neighborhoods anymore you know so let's not hang our hat too much on we need more data we've

got data you know what we're doing now is we're putting that data into effect for the first time

and we're starting to see results and we'll continue to use that data to make more results so

thank you gentlemen. Supervisor Kim thank you chair we've kind of belinger this topic so I won't

say too much but I do want to point out that it wasn't covered specifically in the presentation

but you know I was a little dubious back when I think was measure O that resulted in the city

county partnership when that was passed and some pretty you know lofty goals were set out

before the two agencies brass rings if you will but I'm happy to report that for the second report

in a row all four pillars within that agreement that there's a green dot meaning that we're

you know at least meeting the minimum thresholds which according to the report has you know can be

attributable to the dramatic decrease we've seen in the point in time count year over year so

whether it's broken or whether it's working as intended remains to be seen but we are making

progress and that should be applauded so I want to just heap on as my colleagues did to the praise

the folks that are on the front lines doing the work so thank you. Supervisor Rodriguez thank you

so you know I I can only look at what is happening in Sacramento County and and you know I apologize

if the work the work broken raise some you know some emotions but it is it is a broken system

and and I stand by that I think that I agree that there's been a lot of work on on this issue but

there's I think a lot of work to be done moving forward and you know I'm I'm really interested in

what is holding us back from being able to get people into into housing and how much housing

how much housing do we have to create to get some of these individuals off you know I'm going to

speak to something that is probably going to create maybe maybe a little more angst in people

over the weekend I was reading an article on you know the the the refugees that had come to

the Sacramento area and then it raised a quite it raised just a lot of questions that I understand

we have worldwide issues I totally get that and we want to be a help of a help to people that are

in great need but when I look at the street and I drive around and I see individuals who are

homeless and we have something in the plus 6,000 range off of a pick out which could potentially be

more I look at a system that says are we prioritizing the people who are here unhoused to be able to

get them into housing and so you know I certainly don't mean it to be offensive to people but

it's just the way that I feel and it has nothing to do with the incredible staff that we have or

or it's not it's not that it's just I think where we are today I see things maybe a little different

and so it's not you know I think I hope this is one of those situations where we can agree to disagree

thank you Mr. CEO thank you supervisor sir now I just want to take a moment and thank you all

for your comments but also recognize all the staff that and all the work that folks have been doing

they have a tremendous amount of dedication towards this not only with Emily and her team but also

with Sherry and Tim from Department of Health Services and Behavior Health Services they do a

fantastic job out there we are working on a couple of things as it relates to governments governance

and I think when you talk about a broken system I think you're thinking overall I don't believe it's

directed directly to the county and the county staff and so we do have some governance

things coming forward also like to thank the board for the incredible investment that you've made

we've opened up power in and flooring and power in with a whole host of shelters there we have

East Parkway and we made a tremendous investment in Wad Avenue and we're looking forward to that coming

up up of online soon so so overall I just wanted to take a moment and say thank you for your

comments and your praise to the county staff and I would just like to also convey my appreciation

for all the work that the county staff are doing so and again more things are coming and we'll have

some additional things for you guys to chew on and hopefully some data oh the last thing I would add

is supervisor Desmond mentioned a ride along um staff are always welcome for folks to come whether

it's the hot team the ride along with Kokio or coming to our shelters or any other thing that's

out there that you feel that you need to get more data on or more information on or more than happy

to I know supervisor Rodriguez we have a meeting um I think tomorrow for a couple of hours to talk

about homelessness that's on top of the couple of hours we've already done so hopefully we can

share as much information as you need and get you the data that you feel you need so thank you

yeah and I appreciate the answers to the 20 plus questions that I submitted thank you and I would

encourage ride along's not just the hot team but in particular with our park rangers

regional park rangers specifically in district one and in the that part of the American

River Parkway that is in district one uh basically from um sack state downstream right and I

and I'm going off of just my memory here there's a whole I'm sure we can fill your week with

ride along's activities um to uh get you more um on the ground if you will with all the homeless

service and mental health services and the other services that the county offers so thank you

very much mr chair I think uh staff likes nothing more than a request from a supervisor to come

to a ride along with them so please well unfortunately my back to them so I'm okay uh offering that

all right thank you mr. Villanueva uh madam clerk do we have a member of the public that are

signed up to speak on this matter do not okay uh this was uh uh update right this is just a report

no action that's correct so again thanks to uh everyone including representatives from the city

uh second steps forward uh behavioral health um everyone that uh presented thank you again for all

the uh valued information so on to the next item please item number 36 is the street medicine

and Sacramento County all right I've been looking forward to this one

I'd like to say that the the mobile medical clinic as well if you'd like to do a ride along we

wouldn't have to be to accommodate for sure sign me up thank you madam clerk

as you can see I have a team of individuals with me

chair srna vice chair odd rigas members of the the board thank you for the opportunity to be here

to talk about mobile street medicine services um as you can see behind me this is a coordinated

effort a collaborative effort uh in concert with not just UC Davis providers but also with

Ellica health centers and one community health uh there certainly has been a movement within our

primary care clinic uh what let me let me tell you who I am new alvargist primary health services

deputy director uh under my purview I have uh correctional health services which which is the

youth detention facility adult correctional health I'm not here for adult correctional health

primary care clinic uh and also mobile medicine which is the mobile clinic um we initially started

with a slide deck of about 45 pages and we had to whittle that down given the uh the amount of

individuals that are coming up to talk so vice chair rhodrigas I will tell you we are a little

short on the data and the information but we can certainly get information at your request

um so it's just high level mission goals current future state collaboration challenges and

solutions I'm going to be a bit brief uh so I can allow Ellica and one community to give their

presentations and then for q and a thereafter a little bit about the mission in goals obviously a

partnership in community organizations um talking about wellness without walls it's comprehensive

collaborative compassion at health care uh in concert with obviously other fqhs and clinics

um you know our um outreach is to the streets and campments and temporary housing uh we do work

in concert with co-hewo UC Davis obviously a big partner in that some of the goals that we define um

you know inequities in health care reducing set inequities to health care and access

for those experiencing homelessness um and then also people with limited experience in our

outreach um in the various areas and I'll talk about that in a little bit is actually getting

feedback on how we can improve our quality of services and those outcomes and so that's

obviously a discussion with individuals with lived experience and again the partnerships with

community and governmental agencies not not just uh within a department of health services but

but our dish partners as well and our sister divisions within behavioral services uh included

and public health who could not be here today uh so I'm presenting on the raft uh and then obviously

resources and guidance towards evidence based uh substance abuse disorder treatment which has been

um something that's been on our radar in particular when we look at CalA and prop 47 connections

to the primary care clinic for those just as involved before you leave the slide sure um look

to Shavon um is is that the long awaited van?

yeah so this no this is our van but the long awaited one community van I think they'll present on

that yeah okay all right hopefully there's another van slide here I think this is the only van

on slide but we can certainly follow up with any questions about that van all right

well I will have Dr. Orcelay come up at some point she's here to answer any clinical questions

that I can not answer or anything else related to street medicine so some of the mobile street

medicine services acute urgent care evaluations that's a you know kind of a holistic approach whole

whole person care multi disciplinary team approach uh to health care for street medicine

longitudinal primary care visits a lot of folks ask what does longitudinal mean really it's

a holistic approach with treatment in mind as as the end game at the eye testing sexually transmitted

infection immunizations medication administration and then of course housing health insurance we

working concert with co-hewo we have three sites that we we hit out in the community and I believe

that's dorthgate township nine and however access correct me from wrong doctor orcelac

uh co-hewo has been an absolutely wonderful partner not not only within the primary care clinic

but also for street medicine that is our van there is a link that I'll actually show a schedule

of where we go aside from the three locations that I named we we also we hit various other

pockets that would be safe stay uh flooring looking to expand strategically where there is a need

and that again is in concert with our behavioral health services team and then our community

base partners uh just real quick for those the the mobile clinic is actually an extension of

the primary care clinic which is the Frittalee Qualified Health Center HRSA gives us that designation

and so by extension we are a satellite site can I ask what what what are what are some of the most

um uh common treatments that um patients uh you know receive in in this mobile unit?

I'm gonna ask dr. orcelac to come and answer that question

hello hi um i'm payworthsach and um yes i am one of the physicians on the mobile medical unit

i'm a family medicine physician and also an addiction medicine physician and i care for people

living with HIV at the sexual health clinic as well um so really all of those things i think the

most common conditions that we see are the most common conditions i also see at our fqhc which is

high blood pressure diabetes and um congestive heart failure copd we do have higher rates probably

of substance use disorder and mental health conditions as well that we treat as well and um

because we do rapid HIV syphilis and hepatitis C testing um we do see high um higher rates of

hepatitis C and HIV so we've had multiple new diagnoses of hepatitis C and HIV that have been

encephalis um that have been plugged into treatment and through our outreach to the mobile medical unit

do you can you go as far as because you i've heard now several times it's an extension of the

our you know our brick and mortar clinic uh can you go as far as to administer or offer buprenorphine

and vivitrol and yes um this is um i yes absolutely so i am board certified in addiction medicine and we

do have a partnership um i also am faculty at UC Davis and so we work our addiction medicine

fellows um and we are um increasing our numbers of buprenorphine it's been um um

um uh we do have these numbers but antidotally actually the number one substance use disorder is

nicotine so i think we see the most tobacco use and then methamphetamine second to that um and have

been doing uh buprenorphine for folks a smaller number of folks but yes um we are doing treatment

for substance use disorders and not to get to in the weeds here but uh i think for the longest time

in terms of uh STI activity in the county uh committee has been a real problem uh you mentioned

syphilis and and hiv of what what what about chlamydia is that something that is still like off

the charts for segment of county are we treating it here as well yes i don't have the the data

the second one of county data uh but i do know that we carry treatment um for penicillin onsite on the

RV we carry uh in treatment for gonorrhea and chlamydia um so we are doing treatment for all

of those sexually transmitted infections onsite when people ask them and then a lot of times um with

the risk and benefits discussion um doing things like presumptive treatment so um there's not

it we do do not have a rapid test for gonorrhea and chlamydia um but if someone is symptomatic then

we will offer the treatment for them immediately and can you do referrals to specialists from the

from the vehicle yes so that is a little bit more complicated because of the geographic

managed care system in um in sacrameno the referrals have to come from someone's established primary

care physician and so um sometimes there's folks so i've been going to northgate um since 2022

and so i have a panel of patients that i see in that area um who i do manage their specialty care

and i've been able to get them into like our clinic for havcare um happy to report we successfully

treated her first patient mobily for hepatitis c who completed their treatment got into housing as

well during that time and um so we do have panel and so if someone does a sign to the sacrameno

county fqhc we can refer out um and if not we meet regularly with our other treatmenters and

partners um every other week um with the folks who are providing care in sacrameno county

and are working on building those connections within our stream medicine team so i can connect with

folks who are their pcp's okay and i assume you can do things like open wound care and those

type of things yes wound care hypertension management um we carry um uh assorted uh medications

on site that have been um kind of the highest yield so we have blood pressure medications so if

someone is interested in starting high blood pressure medications we can hand them as they walk

out the door with um starting that and seen some success with that um we do a lot of nicotine replacement

therapy a lot of interest um treating for mild moderate behavioral health depression anxiety um

pretty much full full scope so they're sometimes walking out of this van with the script in hand

yes yes yes so we carry scripts for antibiotics and blood pressure in a couple other

a couple other things but if not we work with pharmacies who deliver to to shelters if they're in

the shelter or um some of our pharmacies were delivered to um general encampment locations um which

has been a great a great partnership does the van or does the more importantly the people in the van

uh does the operation join with other uh county activities on our homeless front so would they

go out with a hot team um we do not go out with a hot team we picked our spots um initially

northgate how and um tonship nine those outreach spots in partnership with community health works

and the parkway outreach team and so they hold their parkway office hours um during the same times

we decided to go so um we were working with community health workers and then the hard team

some is sometimes there as well um yes in if i get that that's a great question uh chair so we

actually have met with the behavioral health services team about synergies and opportunities to go

out safe stay locations so it would be a concerted effort from a county standpoint so you mentioned

some locations both inside and outside the unincorporate area um have you looked into and what it

doesn't make any sense that you might explore a partnership with say uh animal care and control so

they have a mobile unit uh oftentimes people have pets in need as well as their own physical uh

behavioral health care uh have you looked at maybe you know maybe not on a super regular basis but once

in a while um making use of both mobile units uh to kind of get a tofer for for folks that have

beloved animals with them that that's a great idea i don't think we have and we certainly can follow

up and do so okay just a thought sure supervisor Rodriguez uh i just want to say i'm a big fan of

the mobile uh the mobile medical van uh in the past i've done um i've gone out on right along

with two homeless encampments and i've gone with non-profits out into the encampments and one of the

things that always surprised me was the usage of emergency rooms for some basic needs when it came

to health care and so this i hope you're supported by the major health care organizations because

what this will do is help prevent people from going into the emergency room for high blood

pressure medication so i i i do appreciate this the other one is what success do you have with

follow-up care because you mentioned that you will connect with somebody but then do you actually

get success with follow-up care with individuals who are encamps who may not be there the next time

you come around or do they come to you um yes absolutely and we were initially designing this

program there i knew here from from other programs with different designs it's kind of the balance

of do you have consistency and you do do you go to the same spot every time and do we park the

mobile unit the same spot or do we do kind of more directed outreach um and kind of individual

base we like to do go to the same locations kind of two um to address that so i have been parking

and northgate every other Tuesday from eight to 12 for like the last three years of my life and

so folks know that that's where we're going to be and know that um we can come there and so um

yes i there have been been able to build the biggest panel there where we've been kind of more

consistent and um yes just to say the biggest in the biggest barriers are when you know encampments

are moved and when people are moved and that is then people get moved out of the area and having

follow up but we make sure they know that they have our calendar and where we are um to connect

to services so when you give a prescription for medication and they go to the pharmacy to uh

fill it how do they how do they how do they not end up with this financial burden because you know

i mean do you check if they have medical and then if medical that it will cover it okay we do

and i think those are one of the challenges that we'll talk about is for those who are not on

medical or maybe they're in medicals but discontinued that's where we work with cohewo

truly get those individuals back on the medical to ensure that they're not paying out a pocket

and and can certainly go to our pharmacy within the primary care clinic but if there's somewhere

that's more adjacent closer obviously that being ideal situation thank you to great question thank you

all right thank you so um you know just future state um for mobile and street medicine

you know looking at additional locations and then obviously with some suggestion looking at

partnering with other agencies um increasing the number of street medicine service days we are

currently talking with our behavioral health service um sister division and also with UC

Davis School and nursing about expanding uh services in the scope of street medicine also

enhance ECM enhance case management and community sport services through cohewo and obviously

partnerships with county city and community organizations really i will tell you from uh

you know an fqhc primary care clinic standpoint is really for different relationship with our

fqhc partners which is why they are here that certainly has been beneficial to us and to our patients

highlighting the community partners there and then the potential for others the hard team being one

other cbo's uh and then street medicine providers within the state of california

some of the challenges and in some of the questions that have come up here

first street medicine is you know breaking down those silos you know working in in partnership

with each other medical resources restrictive and many clients who do not meet the criteria for

for medical which is most do if not all and so it's just really connecting them getting back on the

medical and not just for medications and medical care but for all the other services within the county

uh some of the other challenges specialty care referrals uninsured clients patients

there's a process by which patients are assigned to the primary care clinic but nonetheless we

can work with them to get assigned to to a clinic if it's not our own and then billing and funding

for services uh hersa does provide grants and funding that's how we purchased the medical clinic

was through a hersa grant and then consistent follow up with with patients with constraints and

uncertainty with with the homeless encampments at move it makes it difficult to track and follow

some of the opportunities and in solutions um you know you talked we talked about homeless

services city sheriff homeless animal control could be added to that list as well um you know

continue need for a collaboration and then more grant funding opportunities and i'm going to hand

it over to elica hill centers who's going to talk about uh their street medicine

hello um my name is margarita from elica health centers this is our associate

medical director for mobile and street medicine Alexander uh portal uh we're going to briefly present

on our mobile and street program and what we have uh done in 2024

um so we have been out in the community provider providing housing views and street medicine

for 10 years uh to date we have three medical mobile units and one dental mobile unit

some of our services in primary care are focused on mostly used in adults our long-term partnership

is with first-step communities where we see a lot of use and adults we provide primary care

wound care our girls house education connecting to col oem services um and other community resources

as well as uh connecting them to house insurance coverage as an fqc we have uh programs for the

uninsured so if we see unhoused patients or uh children used on my in our mobile clinics

we have programs available to them uh that result in zero payment for their visit and may also

result in zero payment for their prescription uh we work with partner pharmacies uh that can accept

our programs and also deliver wherever they are so they can only provide um an address as a street

corner uh they don't have to have uh a home address to get a prescription delivered um

so the goal of the house on views is meeting the patients where they are and addressing their

mistrust in the system and this is why we try to be at the same site every week on the same day

such as with our first-step communities where we see a lot of returning patients so we overboost

walking and scheduled appointments on our mobile site so we can have follow-ups we have patients

knowing that we'll be there next week we'll be after a month after and they they can rely on us

and then they can either continue with us if we are there PCP or we can help them connect to

their primary care provider whoever it may be we also use our mobile services as an opportunity

to educate future providers as a family nurse practitioner and physician assistance

in uh 2024 we had uh over 3,400 visits in our mobile clinics for primary care alone

our services and the calendar of the services are always available on our website for the community

uh in addition we have vaccine clinics and tanto clinics those are school-based services

that we provide currently we partner with San Juan, Robla and Twin Rivers School Districts

we are also going out a starting from next week to get away community shelters to offer

vaccine clinics as well the vaccine clinics we're offering are made possible through a grant

through the Sacramento County House department the funding is really limited it's only for one

year we started in um the grand start in July our clinic started in August um and the

funding is right now in June over this year uh the funding is under the COVID vaccination

grant that the county received uh we as far as we know we don't see any continuation of funding

for this program however we have received some uh feedback from the schools and we're looking

to receive some more formal feedback on how the vaccine clinics impacted enrollment um some um

and a thorough feedback that we're receiving from school staff is that it increased uh

enrollment for on-house use and for the immigrant community and not just enrolling but enrolling

on time as well um and um we have vaccinated over a thousand children just uh during the reporting

period that we're providing which is August through uh almost last year to January of this year

we have some limited dental service at schools uh there's not uh much uh not a big number to report

on that but um dental service for our elementary school kids is also uh important for their enrollment

and also for um their nutrition overall because if they cannot um eat uh no they cannot learn

well uh our street medicine unit has been active for 10 years um one of the advantages of

the way we've been doing it is we've been able to visit the patients directly at their

encampments and their sites in their homes so um this means that when a patient has been moved uh

when um we hear about a new a new place that people need services we're able to go and

meet them where the need is right um now you ask some questions about what services

are provided and we provide essentially the same services that um MJ was talking about after

or select um what I see is to Super Resurra Drigga's point that a lot of

uh people may go to the emergency department for non-emergency issues um this is one way to

address those issues before they need to go in or prevent the need to to go you know

unwittingly uh due to a problem that could be managed outpatient right so uh for example um

um you know seeing a patient for the first time and finding out that you know on on blood

testing they have venenium or um or they have diabetes uh or with vital signs they have

you know pretty high hypertension we can get these uh issues controlled before they become a

bigger problem right so um a lot of the patients that we see in this way are um are unable to leave

their sites you know due to injury illness uh and sometimes transportation you know so

there's a big advantage to go out and and seeing them where they are um also you know a big problem

of course is security and a lot of people are afraid to leave their stuff because it may be stolen

or it may be cleared while they're out there and then they lose pets they lose medications and all

of this stuff um and you can also direct people to sites like Northgate Township 9 you know uh

how access and so forth because we've only been able to do it one day a week um and unfortunately

right now we have no funding so we've had to stop for the time being um one of our units that still

is going out as our veterinary services so uh we have a wonderful veterinary that goes out two days

a week and he he does uh cooperative visits and efforts with um the county with paws um and provides you

know registration uh microchipping um you know some of these vital surfaces for the pets which uh if

you've been to homeless encampments um serve a bunch of needs you know uh companionship warmth security

and so forth so so you're telling us the county now is a model to lean on to figure out how to how to

do it they do they do great stuff i'll tell you um and the services are absolutely wonderful and

appreciated by all involved um so we uh routinely see the same patients um you know

maybe maybe over two weeks we try to go back and find out how people are doing

whether they need additional services but we can also redirect to brick and mortar right which is

the ideal situation um ideal paradigm right so um if they can't get into the brick and mortar though

we do have the ability to go out and meet their needs where they where they live um

anecdotally a few cases uh you know there was a patient i saw for nearly a year you know

treating a wound that just would not heal you know um other patients who have been

unable to get in to see their primary and care provider because of transportation issues you know

the the bus or the taxi comes up and just would not pick them up every single time for six months

you know so they literally can't get in um anyway when funding allows us to go out and work um our

team you know usually comprises of at least four people um more is better and more opportunity is

better right so we do have a an enhanced care management team and a community health care worker

team both of whom have come out with me and collaborated to you know get patients uh access to

more services and uh and if they need to you know get them housing so or get them the resources for

housing um any questions i have a question so uh you mentioned that you know the bus doesn't

pick them up what what does that mean does that mean that the operator does makes a judgment call

and doesn't invite them to or literally just passes a bus stop because there's three of us up here

that also serve on our t-border director so so uh i've seen cases in which um you know the patient

couldn't get on the bus or couldn't get to the bus when they saw the bus or so they're physically

unable physically unable to or if it was a um you know an uber or a lift or something like that

that was ordered for them the driver is just driven away um or their insurance yeah

the insurance uh they may send um transportation services to pick patient up uh we see that in

brick and mortar all the time as well uh that they may not show up may not be there on time

and in case with the unhoused population they may just see where they got to and dry away

just like with uber and lift they will see where they got to and would not want to serve this

person and would dry away because of their appearance because of the fact that they have

maybe they're they're toting their too many belongings or or so yes so simply because they

are they're unhoused and everything that comes with that and how they may appear to them at that

moment all right there there was one case where um you know uh i found a patient who had been dropped

off at the wrong place and the driver had left um but they didn't know how to get back they didn't

know how to contact the the driver so they were essentially uh stranded and uh we don't have the

ability to drive them so we treated the patient on site so we got them what they needed and then

i stayed with him until you know there was a uh appropriate transportation

yeah the supervisor does thank mr. chair good discussion about all these additional barriers to

people seeking the medical treatment they need and kind of as an aside i like the discussion

what you've had about the implications on our emergency rooms and certainly apot when it comes

to that issue as well and well street our street medicine programs and partnerships really has a

positive impact on that apot issue that we're all experiencing but first i just want to thank

alica i mean you do amazing work in the community serving those most at need uh i've seen first

hand both the the dental vans and the the health on wheels program i've heard from administrators

and teachers and the schools how many of the parents of these kids end up using a lot of these

resources when you come out of the school so just been i think a great program so um but considering

some of the barriers and how much easier it would be to treat people if we can get them into a shelter

as you know we're gonna have a great opportunity to do that on what avenue with a shelter right behind

your alica clinic up there so i'm just curious have there been have you had conversations or uh

about that about partnering with the county in that shelter once it's up and running uh internally

at alica yes we are looking to have more discussions with the county about potential partnerships we

have capacity in our mobile clinics as you may see uh next to the future site we have next to

our clinic uh mobile bus parked several times a week that unit and another unit have capacity

several times a week at the moment to serve other sites so we have capacity right now to be engage

elsewhere or at the future site okay thank you i know uh supervisor and our some of our community

meetings and meetings with county staff about this it's very our hope that we will be able to take

advantage of our proximity to alica to really improve the health of the folks who end up um

utilizing that shelter thank you

so we've actually talked a little bit about this about some of the uh unique um

determinants of health uh the pressure you know the the imminent um danger that each of these

patients is experiencing and um the importance to um to get them access to further resources to

address some of those things um why don't you talk about that i can uh finalize on this uh so um

the reason why we brought this up is just to bring up the importance of street medicines

not just having a mobile when go out but actually teams like our partners here go out on food

and have the capacity in the city among our partner and in the county to to serve all the members

that need to be served who are uh unshouted actually staying in a tense on the street um because

it's not simple as getting them transportation or someone watching their stuff while they go to

an appointment it's actually many other things that may not be uh possible for them or important to

them at the time uh they uh need to remember what data is to know they need to go to an appointment

where their right is meeting them and many many other things that um are taken out of the picture

when we bring care to them um and again the reason why we're bringing this up is that we wanted to

say how important is to keep funding uh street medicine uh that both street medicine and mobile

medicine cannot simply uh be sustained on billing uh insurances or other reimbursement uh such as

through HRSA uh that uh there needs to be uh fine balance between uh billing and grant funding

in order to bring care out of the brick and mortal because it simply costs more per visit to go out

and provide care uh one more point to that you were talking about uh collaborations community

collaborations and um of course we're always happy to um to collaborate anytime we have a chance with

you know county city uh another organizations um what I had been doing was I'd been going to

recycling centers uh to places where uh the homeless population congregates and um you know

organically they've formed their own community uh support networks and with the ability to do

something like go out in a smaller vehicle you can go to these sites and

hear directly from them where there is a great need at that time at that day um and that's how

you know I would find a large number of of my patients you know um

unless you're nimble and unless you're able to to drive and change your plans uh that's very

difficult to do thank you thank you

hey Shannon hey how are you doing well how are you good thank you uh chair sarnas

supervisors thank you for the opportunity to speak today um it's a privilege to stand before you

particularly as I have the personal privilege of being a steward of another critical initiative

champion by chair sarna um this afternoon on behalf of one community health i'm here to share some

updates and early successes of our street medicine program a program that with your ongoing support

directly reaches those in our community who are often overlooked and it translates that advocacy

into changeable life changing results on the very margins we are one community health and

FQHC with locations in midtown ardent and car michael and it is our mission to empower all people

through equitable quality patient centered care and in july 2024 we began preparing um and

carefully thought out what our model was going to look like as we prepared for our launch that occurred

just earlier this year in january so this is our team setup we have an advanced practitioner

a nurse practitioner i'm messing up the app uh acronym so excuse me who's provided um our care

delivery we also are onboarding a registered nurse to support with triage philobotomy and support

and care delivery we have two community health workers who are out in the field daily doing outreach

intake and care liaisons and we are bringing our acsw to provide behavioral health supports

so rooted in our values of compassion teamwork service and inclusiveness we offer

psychiatric and behavioral health harm reduction matt medicated a treat assisted treatment services

primary care social service coordination and soon to come will be dental care out in the field

so we have a questionnaire statement from supervisor rhoderius just a quick question so when

you obtain data out in the field do you enter that into the hmi s program we do we also use our

epic health care system out in the field as well that's awesome thank you oh sir no that's okay

so since our program launch i've got some of our early data up here but i think the big ones that

i'd like to call out i mean we've had 480 outreach kits distributed thus far those include things

like food hygiene cold climate supports also harm reduction tools we have 96 patients currently

on our community health workers caseloads we've re-engaged two patients back into one community

health hiv services we have coordinated over 20 uber health rides and i think the most exciting

thing that we're starting to see is we've supported the coordination pickup and delivery of

prescriptions for 38 patients and so not only are we able to carry medications on our team

while we're entering into the field but we can write those scripts if we don't have the medication

available our community health workers work with our in-house pharmacy team to get those filled

and then delivered back to the patients we've also seen eight patients successfully placed

inter transitional housing and this is through a multi agency collaboration i think the biggest

thing i had all this other kind of like data points mapped out but i had the privilege recently to

go out with the street team two days in a row and to see what it actually looks like in action

was quite profound the day really begins with this is our street program manager obriana smith

who has really been the backbone and has been critical to our early successes but obriana gets

her team together and they have you know what would look traditionally in the brick and mortar

like a team huddle where they map out where the locations are they're going to visit during that day

and to our partners with elica to their point that does require a certain level of flexibility

and ability to be nimble because that changes at any moment the first day that we went out we

went to a tiny home village out on stocked in boulevard where there were patients who had originally

engaged in services when they were living intense off of broadway and x-threat and now we're able

with the support of our team to become stabilized enough to enter into transitional housing

there are about five patients lined up ready to go and because of you know our team's ability to

really engage and develop those relationships we've seen that we've been able to maintain that

consistency and that follow up with those patients i think one of the most striking things that day

it was there was a patient who was newly diagnosed with hepatitis C in the emergency room and

the nurse practitioner i think just to see the way that she held space with that patient

who was rightfully emotional overwhelmed did not understand the diagnosis had an adverse

experience in the emergency room the entire visit was focused more on answering questions and

again holding space and reassuring that patient that we were going to be there you know the

fun the following weeks to support him in adhering to treatment and in getting into a more

stabilized place later that afternoon we went back to the clinic and i had a quick debrief

and then it was got to go on a ride down broadway on 26 where our community health worker was

able to identify three different patients like oh that's so and so funny to see her by herself

i need to go back and check on her another thing that popped up we got a call from obriana we had a

patient who had an appointment later that afternoon but we found that that patient actually had a

housing appointment that may have contradicted with the schedule but this community health worker you

know went to this patient's tent was able to kind of tap in and they had the conversation about

what was her priority that day so really truly centering the patient's need and it was determined

that it was important for that patient to get their housing appointment taken care of so that

she could move into the transitional housing to then support with that regular follow-up for the

medical services and i just appreciated the sentiment that the community health worker made at

the end was her voice her choice which has really been central to the entire project and then more

more recently we have established a partnership with loaves and fishes where every Wednesday we

are there from 8 30 in the morning until 12 30 in the afternoon supporting patients in front

ship park which has been wildly successful and we've started following a panel of patients there

i think you know to dispel a myth there's a lot of questions that we have received about safety

and how are we you know engaging in situations that may appear to be high conflict but i think

that what has been really incredible to see is and this is in part the trust that the team has

established is just the there is an unspoken understanding and i think something to be said that

is quite profound about bringing the humanity back to those that we often pass by when we're driving

so we thank you for the ongoing support you know ultimately our street medicine program is about

more than just providing health care it is about restoring dignity and building pathways to

to stability and with your continued support we can ensure that this model of compassionate care

reaches even further transforming lives and strengthening our entire community so thank you

and i brought you a little present these are some bracelets that we give out to patients that we

encounter or other community members as healthy together on the outside but they're functional

and on the inside it has our street medicines direct line where patients can text or call

so thank you i do i do have a question i'd be giving to the the clerk's assistant right behind you

there you go she's she's stealthy that way i know the question and this actually goes for everyone

we've heard from and it's a heads up for our department of health services which i believe

we're going to hear from next thank you what i haven't heard so far is how do you do do all of us

interact with those that are unhoused that are pregnant and in need of

you know that unique type of care and you know i know most people in front of me know and understand

that plan parenthood is first and foremost it's a part of our it's an important part of our health

care system that certainly kind of can help in that regard do we have a partnership with plan

parenthood so maybe someone can speak to that i saw the doctor get up so yes so i am a

feeling medicine doctor so i do prenatal care and so with like we mentioned we are a satellite

of our fqhc and so have it has come up less often than but have been able to connect folks

into prenatal care either through their fqhc where they've already been established and are

assigned and help kind of navigate that with our community health workers there or we have a

prenatal clinic at our family medicine clinic as well and so we were able to to do that as well

that staff by family medicine physicians you prepared to in the mull be units like provide vitamins

for for women that you know need that particular type of nutritional attention for their

you know to enhance their healthy pregnancy hopefully yeah definitely i'm prenatal vitamins are

covered by medical so we don't carry prenatal vitamins we're good we should but we are able to

write prescriptions and and draw lab works are able to do prenatal lab work as well we obviously do

HIV syphilis and hepatic testing on everybody in gonerian comedia most folks who come in through

the mull unit but we are able to get additional blood work in samples and and then connect them

i think i have actually not come in contact with a person who has needed that but i know some of

our other co-workers who are working at more of the safe stays have been connecting people back into

care see another doctor popped up behind you in each case that i've i've i've addressed

the most vital thing was getting shelter right away and we've been able to get them resources

immediately in one case i think even within the week and in another case i was no longer involved

after that initial encounter so i don't know what happened but they were connected with those

resources um living in the elements would be especially difficult during pregnancy which is

why i believe that's vital yeah absolutely thank you thank you shanne

sure so now thank you again board members for the presentation any questions is it

oh oh there we go so that concludes the totality of the presentation yeah supervisor shanne

i was just going to mention so noelle and dr. urse like presented for the from the counties perspective

and we i was simply reading down an order on the right hand side there so yeah no and so one of

the things we are working to do is better integrate the street medicine programs into our overall

homeless system of care as you heard here so we're looking forward to enhancing those partnerships

over time great thank you supervisor Rodriguez thank you for the presentation so when it comes

to funding i'm not sure if this is a stock report that i read that but was there arpa money involved

in in this and so what does that look like going forward where there's no more arpa money

that that's a great question i think the arpa money is flowing to one community as i understand it

and so once that goes away obviously some of the sort of it's come on yeah um

yeah funding streams for all street medicine um seemingly under attack it's all going away and so

obviously with that means a diminishing services for the homeless community um one of the things

that we're actively working on is establishing contracts with the health plans so that we can

receive reimbursement for the care that we are providing in the field um but also coupling that

with the realities that that may not cover the cost of running the program um which we are

finding right now with ours it's you know we're looking at a little over a million a year

to sustain this um we're looking at a multi pronged approach so both those reimbursements looking at

how you know we can leverage our onsite pharmacy but then also exploring other uh funding opportunities

through her set through local initiatives um and of course leveraging those partnerships and

making sure that we are supportive of all of our you know colleagues that are in the field working

alongside um USC school of medicine the kex school and their street medicine initiatives also with

the um street medicine institute where we're all working together to learn best practices to

inform us sustainability plans and I think the biggest thing is and I know you know you know we all

you know sharing the sentiment is how critical it is going to be to continue to provide these services

and how it's you know I don't the right word is escaping me but just it's almost worse off to begin

services like these and then stir up them away from those community members who need the most.

The sustainability is always you know the we've ran numbers on maintenance for the van staffing the

van mobile clinics and so certainly you have to see a set number of patients to stay ahead and

and meet the demands and so I think the reimbursements and the number of patients we see in the

encounters that are billable aren't enough to sustain the overall maintenance and operations of

street medicine so those are there in lies the rub. So we have four you know as I mentioned earlier we

have four major health um hospital systems in the area that would definitely benefit from having

individuals not go use the emergency rooms as um preventative services or care so I hopefully

there's a partnership and some support. EED utilization is always at the forefront of what we do

obviously the services that are needed for the homeless but but again we we have those discussions

all the time about EED utilization and cutting that down. Absolutely. I'll just add that the

ARPA funding that has been referenced was some that came from the from district one some of the

very first things that we discussed was sustainability because I wanted to make sure that if

the county was going to invest and partner with one community health in terms of enhancing a

street medicine model that was going to be effective that we're going in with i's wide open and

realize Narpa's one time funding but I think the general sentiment that was shared by both

one community health and and our office was that well let's at least have something to talk about

let's have something to design at least and get off the ground and um and looked at it quite

frankly from a capital expense versus operational expense um perspective so that at least you had

some new tools uh whether it be the mobile units themselves or or you know other things that

could be used as a catalyst to kind of design um personnel needs and deployments um so I'm just

delighted to see that we're making progress in that respect and um look forward to again the day

that I can go out and do a ride along and see for myself all the good work that's being done

survival. Absolutely. Just I'm going to be a little repetitive here but I want to you know

thanks to Professor Surin for what you did with those ARPA funds that's incredibly important um but

for the most part and anybody out here can answer it most uh you know we we made a real concerted

effort utilizing ARPA funds whenever we could for one time expenses and knowing and not building on

and and relying on those going forward uh as operational expenses is that accurate? Yes that's

that is yes no that's very accurate and these were one-time investments you know the um one thing

we are watching very closely is the federal impacts to medicate a Medicaid because a lot of these

services that they're talking about do will require that um sustained funding over time but

we're we're looking at that closely thank you. Other questions or comments from board members

Madam Clerk do we have anyone from the public sign up to speak um let me check on that really quick

no we do not have any speakers for this item great thank you and again thanks to everyone who

took time to be here with us and present and inform job well done thanks thank you all right

our next item please item number 37 receive a second quarter fiscal status report and

approve an appropriation adjustment request for various departments. Good afternoon chair

Sourna board members I'm Amanda Thomas the county's chief fiscal officer um here today to

present the second quarter we sometimes call mid-year fiscal status report for fiscal year 2024

25 um I will endeavor to be a little bit more abbreviated than I might normally normally be

understanding that we're running a bit behind schedule but I did want to start off just

acknowledging like most times when I am up here I'm here to talk about work that a lot of other

people have done um so I want to thank the fiscal teams in the departments um and my team in

the office of budget and debt management um for preparing and analyzing these estimates that I

will be talking about today. So um to start off um just as an overview I am going to be talking about

estimated revenues and expenditures for this current year uh current fiscal year 2425 that's based

on actual data available as of December of 2024 and any other information available as of January

um as you'll see overall expenditures in most departments are estimated to be lower than budgeted

and then I will discuss later there are certain budget units that require appropriation

adjustments to increase or transfer appropriations um in order to be able to cover estimated

expenditures uh discretionary revenues in the general fund are estimated to be higher than budgeted

but I'll note that this is largely due to a one-time adjustment um which I'll discuss more later

so overall in the general fund those higher revenues and lower expenditures result in an estimated

71 million dollar available fund balance carry forward for the 2526 budget um so this is probably

where I'm going to spend the most time talking today um I'm going to talk a little bit more later

about how we came up with that 71 million dollars but I think this chart helps put that number

in context um and I know um uh you've seen this before but just as a refresher the top of the bar

here is showing us the um total amount of beginning general fund fund balance available in that

year's budget um the blue part of the bar is showing how much of that amount we use to fund

appropriations in the budget and then the orange part is showing how much was set aside in reserves

so as we've talked about before and as you can see here during the COVID years we saw really

unusually high levels of fund balance due to a variety of factors um and the good news is that

during that time if you know if you look at that orange we were able to set aside quite a bit in

reserves um so that's the good news the bad news is that we also um you know looking at these numbers

became overly reliant on fund balance which is really a one-time funding source um to fund

expenditures which sort of continued and exacerbated uh a structural imbalance we have in our budget

so if you look at that 71 million dollars which is this gray bar here available for 25-26

you can see that it's significantly less um obviously than those really high years but also less than

the 112 million dollars um that was available for this current fiscal year uh of which about

80 million dollars is funding ongoing expenditures and this year was budget um so creating a gap

in funding both of ongoing expenditures um and also impacting the ability to continue to fund one

time expenditures okay so the next several slides are really just going to to detail um the estimates

of revenues and expenditures that get us to that 71 million dollar estimate um for general fund

discretionary revenue as I mentioned is estimated to be higher than budgeted about 25 million

dollars in total and we'll go through all these bullets I think the important point um to know is

that really the largest contribution um is our sales and use tax revenues which are estimating

to be 18 million higher and that is largely due to a one-time adjustment um resulting from an

under a cruel of prior year sales tax revenues so I think the important thing to note is not that

ongoing revenues are performing a lot better than we thought it's mostly that we have this one

time adjustment that is continuing to be under a crew uh so so the our sales tax revenues are earned

in the fiscal year that ends um June 30th but they actually come in in the the subsequent three months

it's a structural thing exactly yeah so we had to have to come up with an estimate and that

estimate under a minute yeah good question okay um so turning to look at semi-discretionary

revenue which is another large category of funding in the general fund so this is our realignment

and proposition 172 revenue um which are largely based on state wide sales taxes overall we have

about a 14 million dollar increase um but I think it's important to note that that's that's the

net result of a 15.7 million dollar increase in our non-Cal works related reimbursements which

really don't impact the use of discretionary resources and then we have about a 1.4 million dollar

decrease in all other reimbursements um which do impact the use of discretionary resources

and that that decrease is resulting from a combination of lower estimated expenditures and some

categories and lower available revenues and others really as we've seen state wide sales tax

revenues perform below expectations um so the the third thing that we look at is sort of what

what the net financing uses in general fund departments are and that is a function of expenditures

in those departments um and then offset by departmental revenues and reimbursements so looking at the

net result of all of that um we see a 23 million dollar decrease in the net departmental expenditures

funded with discretionary and semi discretionary resources so overall lower expenditures and

departments partially offset by lower revenues and reimbursements and departments but a reduced

need overall of 23 million dollars compared to budget so the math of that is that we have a 25

million dollar increase in discretionary revenue um a 14 million dollar increase in semi discretionary

reimbursements that 23 million dollar decrease in the use of those discretionary and semi discretionary

resources so that results in a 60 million 62 million dollar estimate of fund balance as of the

second quarter um but as we know that estimate historically has understated what the actual fund

balance ends up being so we're adding in a 15% adjustment here to account for that historical

difference um with the result being the 71 million dollar estimate which would be available for

the 2526 budget um in addition to the the estimates that I just described um the other you know

the other uh well the action that we're we're asking for today and the other part of this mid-year

review process is to look at budget adjustments that are required um at this time and so as I noted

earlier most departments anticipate having more than sufficient budget appropriations to cover

expenditures but there are some budget units where adjustments are needed um I'm not intending to go

over each of these individually but I'll just note that those that are listed um under the first

main bullet are funded either by additional revenue or a budget transfer so there's no impact on

the use of discretionary resources for these adjustments and then for those that are listed under

the second bullet those do impact the use of discretionary resources um with a net kind of all of

these changes resulting in a use of general fund contingency of approximately 2.3 million dollars

which would leave a contingency balance um of approximately 4.8 million dollars after these adjustments

and that concludes my presentation happy to take any additional questions thank you uh I have a

question um and maybe um I'm asking it the wrong way but I'll ask it anyways so if we have if

we're looking today at an estimated 71 million dollar fund balance if we were to apply as a matter

of what we have set in policy the percentage for reserve and um for contingency what is that what

is that how do I think how do we think about that today as a starting place relative to the 71

million sure so um so the 71 million is obviously only one piece of the budget picture when we look at our

reserve and contingency policies they don't actually speak to fund balance or reserve policy um looks at

first um maintaining a minimum percentage of our discretionary revenues um you know in in our general

reserve and then overall establishing a target that's based on total general fund revenues so

while fund balance becomes an available source for those reserves I mean I'm referring back to your

bar chart because maybe it's not in the policy but historically that's where we have looked

for for both appropriations and reserve exactly but and in earlier years we didn't really have a

contingency policy so that's why I'm asking that let's say we all approach this from a hyper conservative

perspective when I say this I mean the recommended budget uh and we start from a place of what do we

think the what are the minimums that we should be having in the back of our minds about uh the the

minimum percentages that we ought to prioritize and if necessary prioritize from fund balance

yes I so I think probably a useful way to think about it is because we know that this fund balance

is one time funding ideally a hundred percent of it would be used either for reserves or one time

expenditures I think I think as we've known and talked about it's going to take the county some time

before we can get there right if we think about you know 80 million dollars is funding ongoing

expenditures this year um you know we really need to we we need to continue to sort of manage that

down um doing that all in one year obviously would would be very impactful okay uh Mr.

Villanueva I think what you're asking for is the policy as we run into the September budget where

we actually are the policy actually says for us to sit set aside a certain percentage of our our

fund balance and maybe the manic and talk on that right so so when we when we come in June with

recommendations um you know I what what we typically have done in the past as we have also identified

some growth that might be prioritized for funding in September should we have additional fund

and some of its mandatory right and then and then what the policy says is any fund bonds beyond that

we should put in reserves so thank you David. Gotcha all right questions for Amanda

don't see any I'm clear do we have anyone signed up to speak on this? We do not

I don't know why Siri thinks it's time to let's second okay we have a motion and a second

please vote

and that mushy does pass very good next item

item number 40 is county executive comments thank you Nicole um if I can ask Metro uh

cable to put up the picture um today we've had a lot of discussions about the homeless and the

and the services that we provided the homeless and I think supervisor serna made a good point to

recognize um our pause our pause um mobile which is our pet aid and wellness center um well this

year we were celebrating its one year anniversary we actually started it back in about December

but uh doctor mid calf has done a wonderful job getting out there and um and providing these

services and appalled pauses a full service veterinary outreach clinic on wheels dedicated

purely to the unhoused and providing services to the animals and the pets of the unhoused

community residents um services provided by pauses include spain neuter surgeries

medical treatment and testing vaccines and preventative care microchipping and they also

have uh leashes and food and a whole host of pet pantry and supplies this year they were able to do

about 1500 exams spain neuter almost 500 animals and then also provide 11,000 wellness services

and vaccines as I look at this picture earlier I was noticing this is the flooring road safe stay

I can um I can see that and um so they do do spend time at the safe stays along the river also the

bike trail uh american river and a whole host of other pre designated areas and I think it'll be a

great opportunity for them to also work with the medical uh uh medical staff um you know doctor

mid calf I had the opportunity to sit with her last Wednesday at a fundraiser in a celebration event

with with this and she is just um incredibly dedicated to this work and especially the animals

for the the homeless and the unhoused um but um I just really appreciate her work and her

her dedication to it so I wanted to thank her on that on top of that um if Nicole can put that up

we um we are coming forward with um our 2024 year and review today this is our award

winning annual report that we has a whole host of stats of facts and figures for all our county

departments including property tax dollars median income housing value and age of our population

and much much more some key statistics that I would just point out in there is um in 20 since 2015

we've reduced our our use and foster care by about 58 percent um child support services has collected

about a hundred and twenty nine million dollars last year preventing children and families from

falling into poverty and transportation is filled almost 91,000 potholes and removed almost

132,000 square feet of graffiti so I think this is a great thing you should already um if it's not

already in your office they will be in your office for you to share with your community um and we've

also sent them to the other counties to boast about all the great work that Sacramento County is

doing so thank you to everybody on the team I couldn't do it without the team behind me I have an

excellent executive team and our department has our fantastic so thank you for the time

and hopefully you're going to send that to C-SAC right we are sending it to everybody

comments from my colleagues all right to Roger Kenny thank you chair I just wanted to thank

you know David thank your staff and all of the those that came out for the neighborhood clean up

down in South Sacramento about 10 days ago um it was a tremendous success it's kind of funny all

these people coming up with you know trailers full of garbage and and it's not usable stuff

and thanking us and you know I want to quit that thank you because we realized that had you not

brought it here you'd be dumping it somewhere else so um but it was a huge success but I

particularly want to call out I mean Barry Chamberlain and his staff they were all out in full force

even some of them had their kids volunteering not sure how legal that is but yeah they were great

and then I want to give a special shout out too because way above and beyond was Troy Gibbons

that guy worked his butt off that day and it's much appreciated thank you thank you supervisor

supervisor Desmond thank you Mr. Chair um so I Senator Ashby Sacramento County has a bill

Senate bill eight that would codify a temporary disability benefit for park ranger peace officers

like our own park ranger officers here and Mr. Chair I request that this would be agendized for

us to get a presentation about that legislation and for us to consider supporting it as a county

my understanding is that is actually a temporary disability benefit that we provide as part of the

contract for our our peace officer rangers but I'd like to explore actually supporting the

legislation that's something that certainly we can do what I if you wouldn't mind a friendly

suggestion is I would encourage in the spirit of exploration about what the bill entails having our

bless you our county CEO perhaps alongside those that are involved here on our legislative agenda

maybe schedule one-on-one meetings with supervisors to have a conversation about kind of the details

because I'm hearing different things about it and I want us to make if we're going to make a

decision about it to make an informed one so I'm not sure if that's what you were suggesting or

or not but I would have us kind of go through that exercise first if that's something you're

agreeable to. I'm fine with that I don't want that to I still keep my request that this eventually

come back to the board for consideration I know we're going to it comes the the the legislation

goes to its first committee here I think tomorrow I don't know why it would would come to the floor

so we certainly have enough time to do that so I'm certainly fine with that but my request remains

that this come back for the board to decide whether we would like to endorse it officially or not.

Okay thank you. So you're welcome Rodriguez. Well I want to wish the best of luck to district

four resident Julian Jimenez who as he continues his food network battle we're excited to see him

represent the Sacramento region and showcase his culinary talents on the national stage

as of last night Julian who owns Julian's past

pet history and cafe is still running for the food network spring baking championship.

Then I want to give a big thank you to the Sacramento County Sheriff's Office and deputies for

their successful human trafficking sting operation last Friday night by working under cover

and posing as sex workers they took action in the Watt Avenue area which has been a long hotspot

for these crimes their dedication to protecting our communities truly appreciated

and in honor of women's history month I have a couple of recognitions one is having founded over

474 free public libraries and 4,655 traveling libraries women's clubs were credited by the American

Library Association with establishing 75% of America's public libraries supporting local

libraries continues to be the Federation's priority today also recognized Darcy Brewer the CEO

and Angela Terry the CEO the California Capitol show these two ladies have done a remarkable job

managing their air show and all of the intricate details that go into the planning of the event

and also give a shout out to one of my best friends who Stacy Patterson who will be retiring after

34 years of law enforcement and of those 21 she has spent with Sacramento County Sheriff's Office

so congratulations on your retirement and that's it. Great thank you supervisor Hume.

Thank you chair I have a question that I initially thought was going to be directed towards

deputy executive Jones but in speaking with him because it is existing litigation I should

directed to county council I received a phone call about I guess there was a hearing the other day

on status of Maze consent for lack of a better term and apparently the judge expressed some

frustration or annoyance over the lack of definitive timeline for solutions and set some sort of

deadline coming up in June as I understand it where there's more clarity to be provided

and so I guess I'm just wondering do we need to do something proactively as a board in order to

move up the timeline that CGL gave us I think is a year and a half to two years to go through

the process to identify preferred solutions do we need to do anything in order to be a little more

proactive sure I can address that and since as you recognize this is existing litigation I'll just

give you a high level report and we will be scheduling something for a closed session to give you

more detailed analysis of the status conferences as you recognize that judge has scheduled to twice

yearly status conferences and we did have one last Thursday and you did use the correct adjective

concern dismay at the lack of progress for the the health facility so she did set another interim

status conference for June 23rd in which she requested a timeline a definitive timeline

for how we are going to address that facility it is my understanding that my office is meeting with

deputy county executives today to present a timeline to figure out how to meet those deadlines I don't

think at this time there's anything that the board needs to do since it was just last Thursday we're

really in the planning stages and understand that this needs to happen and we have every intention

of doing so so I don't think the board needs to do anything at this time we're figuring out how we

will do that and have every intention of doing so okay great thank you and I look forward to that

closed session thank you thank you I have a couple things first I want to join supervisor Rodriguez and

thanking Darcy Brewer and Angelotary as was mentioned terrific capital

health on your capital air show featuring the blue angels exhibition team and many others including

the war board the warbirds both static and fly by performers it was great weather and I had the

unique opportunity to be out there all three days and in addition to Darcy and Angelot Angelot

want to thank the sponsors I want to thank Cindy Nichol her staff and the entire airport

system they are a major player in making sure that that is a successful air show every year I want

to thank the army of volunteers that pull off the air show and do so giving up their time and energy

so freely I want to thank the first responders that were there to make sure we had a safe experience

and we all look forward to next year but this year was very special we had it in the spring

it's not the first time but it's been the first time in a while and I thought it went

great better than expected quite frankly and the second item I have I need my short timer chief

of staff leaves Sonava to join me at the podium

they should go to the rest of the team

here

so I think everyone here is aware that after but nearly 12 years

yeah my chief of staff my very capable skill talented veteran chief of staff

Lisa Nava is going to be leaving the district one office and is going to be serving as

mayor of parties chief of staff it's a return for her she previous to working with us in our team

here in district one worked with then council member Rob Fong so she's returning to some familiar

a familiar environment I'm sure she will you know excel just as well as she she has here she's been

just an incredible partner to work with over these years and certainly has kept me checked when

I need to be checked and just does a wonderful job of managing our limited human resources but

again very capable human resources our friends Monica Mr. Chong as she likes to say and

Lydia Frazier who couldn't be here today but I just wanted to make sure she understood how much

I've appreciated that partnership and the experience working with you over these years you've

made a difference to me but more importantly you've made a difference to our constituents who

really lean on our office not daily but hourly and you know doing performing the the art and

science of directing constituent concerns to the appropriate resources is a very unique thing

and she does it very very skillfully so we always do the best in your your new capacity working for

the mayor and I think what we get out of it is we get to have that remaining connection there and

we've talked a lot today about our partnership with the city and so this is kind of one more extension

of that but thank you for everything you've done. Thank you thank you. I'm going to enjoy

looking at that. I'm horrible with plants and trees as the floor can tell you they're beautiful.

Thank you I did not expect this I'm a little overwhelmed. I've really enjoyed working here

and thank you Phil for giving me the opportunity if I never did that I would have never had the

pleasure of meeting all of you and working with you it's just it feels like a family so I'm really

going to be bummed to leave you I'm just going down the street so I hope to bump into you and yes

you will always have a friendly face in the mayor's office so just give me some time it's going to

take some time to get my feet under me I'm sure the city's changed a lot I still have some old

friends there so I'm looking forward to reconnecting but I will really miss you all and I can't even

tell you this side of the table your expertise and your staff have been tremendous so we couldn't

do what we do without your help so thank you thank you thank you this isn't goodbye it's just

I'll run into you so and you all have my cell phone I'm not going to list it on this

on air TV but of you all have it so reach out anytime and I'm there so thank you appreciate it can I

get a picture with you want to come down to hey Lisa first of all it's 916

but but I always say is it's been a huge pleasure working with you we've been friends long before

but don't forget from where you came okay thank you yeah probably up to the side

these things taller than me and I guess I can help you hold it how's that oh okay

and then you guys yeah yeah we'll have to get a cardboard cut out of Lydia yeah right

thank you thank you thank you everybody appreciate it thank you and I just want to take a minute and

also note that I'm also fortunate that umma mungus has accepted an offer to serve as my next

chief of staff and so I'm looking forward to that we all know Alma and and I can't wait to

get to work with Alma and I spoke to her earlier today says it'll give I'm I mentioned this she

goes well sewer district doesn't even know so Christoff if you're watching

but no in all seriousness I I'm really blessed to have worked with some some great chiefs and

and Lisa's been the longest tenured and I look forward to the next chapter of district one with

with Alma so thank you

all right if there's no further business before this board we are adjourned

yep

you