Minutes of the Health Commission Meeting Tuesday, September 17, 2002 At 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The meeting was called to order by Commissioner Edward Chow, M.D. at 3:10 p.m. Present:  Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner John I. Umekubo, M.D. Absent:  Commissioner David J. Sanchez, Ph.D. Commissioner Chow noted the resignation of Commissioner Arthur Jackson. This will be a great loss to the Commission. Commissioner Jackson was dedicated to the Health Department and provided wise counsel. Commissioner Chow announced that he is appointing Commissioner Monfredini to assume the role of the Budget Committee Chair for the remainder of the year. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF SEPTEMBER 3, 2002 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) approved the minutes of the September 3, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Monfredini chaired, and Commissioner Umekubo and Commissioner Parker attended, the Budget Committee meeting. (3.1) DPH-Administration - Annual Report of Gifts Received in FY 2001-2002. Commissioners' Comments Commissioner Umekubo thanked the volunteers at both Laguna Honda Hospital and San Francisco General Hospital for their hard work and dedication. (3.2) CHN-Office of Managed Care - Request for approval of a no-cost contract modification with San Francisco Health Plan to reflect a change in the funding, so that $2,029,000 in Proposition D, Children's Funds, can be used. Commissioner Umekubo abstained from voting on this item. (3.3) CBHS-Substance Abuse - Request for approval of a retroactive contract renewal with Jelani, Inc., in the amount of $2,583,429, for the provision of residential and outpatient substance abuse treatment services, for the period of July 1, 2002 through June 30, 2003. Jim Stillwell said that the agency's submission of reports has been timely since the monitoring report. The more problematic issue is client turnover. DPH still believes that the number of patients who complete the entire program needs to be higher. Staff wants to continue to explore the options for improving retention. Commissioners' Comments Commissioner Monfredini said that, while the Commission is committed to the agency, there are concerns about turnover, and asked the agency to describe how it was going address this issue. Gwendolyn Johnson, Executive Director of Jelani, said they are looking at a new program structure. The summertime is when they have the most problem with retention, so they will be focused on developing summer programs. Commissioner Monfredini asked that an update be given to the CHN Joint Conference Committee in 60 days. Commissioner Parker asked if the Proposition 36 model is different from their other programs. Ms. Johnson said that there are some differences due to the requirements of Proposition 36, but the programs are mostly similar. Mr. Stillwell said that the Proposition 36 clients participate in the outpatient program, which has been performing relatively well. (3.4) CBHS-Substance Abuse - Request for approval of a retroactive contract renewal with Mission Council on Alcohol Abuse for the Spanish Speaking, Inc., in the amount of $846,484, for the provision of substance abuse services, for the period of July 1, 2002 through June 30, 2003. Commissioner Monfredini and Commissioner Umekubo asked for a report after 3 months to the Community Health Network Joint Conference Committee. (3.5) CBHS-Mental Health - Request for approval of a retroactive contract renewal with Community Vocational Enterprises, Inc., in the amount of $1,193,667 per year for four years, for a total contract value of $4,774,668, for the provision of vocational support and employment services, for the period of July 1, 2002 through June 30, 2006. (3.6) CBHS-Substance Abuse - Request for approval to retroactively accept and expend a grant from the Substance Abuse and Mental Health Services Administration, in the amount of $1,000,000, for Treatment on Demand Services and Evaluation, for the period of August 1, 2002 to July 31, 2003. Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) approved the Budget Committee consent calendar, with Commissioner Umekubo abstaining on Item 3.2. Item 3.3 will be reported back to the Community Health Network Joint Conference Committee in 60 days and Item 3.4 will be reported back to the Community Health Network Joint Conference Committee in 90 days. State Budget On Thursday, September 5th, the Governor signed the 2002-03 State budget - more than two months after it was due. The Governor signed a $99 billion budget and used his blue pencil to veto $235 million from the budget submitted to him by the Legislature. The budget includes $7.5 billion in reductions for a number of state programs, including some health care programs; billions of dollars in loans; and an unspecified $750 million reduction in State administration. Though most of the vetoed funds were allocated for health care, social service and county programs, the cuts were less severe than anticipated and the budget still retains many of the programs the Governor had previously proposed for significant reductions. The budget was passed without increases to the State's cigarette tax or the vehicle license fee. A more detailed report on the budget will be presented to the Health Commission on October 2nd. Older Adults and Traffic Safety Michael Radetsky, from the Community Health Education Section, served as a member of The California Task Force on Older Adults and Traffic Safety, which recently issued a final report with recommendations. The report, a product of an 18-month planning effort, is the first step in a coordinated statewide effort to improve traffic safety for older Californians. The Final Report is available on-line at www.eldersafety.org/oats/finalrpt.pdf. Southeast Neighborhood Jobs Initiatives Roundtable On August 21st, Adult Mental Health Services sponsored a roundtable discussion on workforce and economic development. The goals of the event were to create a community agenda on jobs, inform the community of existing opportunities, and work together to meet the challenges of the community. Approximately 250 individuals attended the event, which was moderated by Belva Davis of KQED and Supervisor Sophie Maxwell. Western Addition Town Hall Meeting on Breast Cancer On Thursday, September 19th, the Department’s Breast and Cervical Cancer office will lead a town hall meeting on breast cancer services in the Western Addition. The town hall will be held at Rosa Parks Apartments, 1251 Turk St from 6pm to 8:30pm. Since our first town hall on breast cancer in 1998 there have been seven additional town halls. While the program is open to all San Franciscans, low-income women over 40 years of age with a particular focus on women between 50 and 64 years old will be our constituency for this event. The program will include a panel of women from the community living with breast cancer to discuss their individual experiences, overview of breast cancer by Judith Luce, MD followed by a question and answer session with the participants. In addition to the town hall program, from 1pm to 6pm we will provide a women's clinic with clinical breast exams, blood pressure and diabetes screening, acupuncture, dental screening, massage therapy, stress reduction workshops, consultations with health care providers and mammograms provided through the UCSF mammography van. Chinatown Child Development Center 30th Anniversary The Chinatown Child Development Center (CCDC) will celebrate its 30th Anniversary on September 25th from 3:30 p.m. to 6:00 p.m. The Center has been providing an array of multilingual and cultural services to families and individuals in the community since 1972. At the Center's location at 720 Sacramento St., staff provides services such as group, family and individual counseling, medication evaluations and even socialization groups for children. Over the years, CCDC has developed strong relationships with other service providers, facilitating a strong sense of community among staff, patients and the community-based agencies who serve them. I know the Commissioners join me in congratulating the Chinatown Child Development Center and its staff on the important role they play in protecting the health of this diverse and vital community. COMMUNITY HEALTH NETWORK SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT September 2002 (From 09/09/02 MEC and 09/10/02 JCC) 09/02 2002 YTD New Appointments 37 169 Reinstatements 1 Reappointments 32 308 Delinquencies 0 0 Reappointment Denials 0 1 Resigned/Retired 16 155 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Changes in Privileges  Additions  Voluntary Relinquishments  Proctorship Completed 2 4  23 10  10  122 Current Statistics - as of 09/01/02  Active Staff  Affiliate Professionals (non-physicians)  Courtesy Staff  Referring Staff  Total Members 390  145  491  42  1068 Applications In Process  Applications Withdrawn Month of Sept 2002  SFGH Reappointments in Process Oct. to Jan. 2003 49  2  161 15 YTD 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF SEPTEMBER Commissioner Guy presented the Employee Recognition Awards for September. Individual Awardee Division Nominated by Suzanne Garnier, R.N. CHN - Health at Home Mary McCutcheon, Diane Jones and Pamela Bohmann, Health at Home Team Awardees Division Nominated by Environmental Health Services, Complaint Program, Field and Support Staff PHP - Environmental Health Services Helen Zverina, Supervisor, Complaint Program 6) PRESENTATION OF THE SCHOOL HEALTH/WELLNESS CENTER REPORT Sai-Ling Chan-Sew, Director, CMHS, CYF Section, presented the School Wellness Center Report. The Wellness Center initiative is a collaborative effort of the Department of Children, Youth and their Families (DCYF), DPH and the San Francisco Unified School District (SFUSD) to support adolescent health and wellness. The centers bring together a wide range of integrated health, behavioral health and support services at high schools. The wellness centers emerged from a youth-initiated process spearheaded by Youth Making a Change and are located in seven high schools. Youth identified behavioral health, reproductive health and linkages to health resources as their primary needs. The goals of the wellness centers are to increase: Youth’s awareness of and access to health services Health-related information at all grade levels Linkage between school administration and the wellness center Outreach and linkages to community partners Youth’s healthy behavior and capacity to develop personal and social skills Access to substance abuse prevention services Access to mental health services Youth’s attachment to school Youth’s academic performance The wellness centers provide direct services, health resources and education and referrals to community health clinics and services. Direct services include health assessment, case management and mental health and substance abuse counseling. Ms. Chan-Sew gave an overview of the budget for the program. The annual core City funding is $1.4 million, with $700,000 coming from the Children’s Fund and $700,000 from the General Fund. Each wellness center has one wellness coordinator, two days of nursing, one half-time mental health counselor, one half-time substance abuse counselor and one peer resources coordinator and $2,500 for medical and office supplies. Many of the centers have a community health outreach worker. Over 30 organizations have partnered with wellness centers to provide onsite services and linkages to the community. The total number of students in the seven high schools with wellness centers is 11,750. In the 2000-2001 school year 3,934 students were served. Based on the total budget of $1.4 million, the cost per student impacted is $119. The cost per number of students served is $356. For the first semester of the 2001-2002 school year, 2,175 students were served. ETR Associates, an evaluator for SFUSD’s school health programs, found that when wellness high schools are compared to non-wellness schools in the district, wellness schools had: 5% fewer students reported problems with depression or having considered suicide. 5-15% fewer students reported using tobacco, drugs or alcohol. At least 15% fewer students reported having been offered or sold a drug on school property. Ms. Chan-Sew presented three case studies of students who have utilized the wellness centers. Ten high schools to not have wellness centers. One of these is Balboa, which has a teen clinic. Challenges Sustainability Commitment of $1.4 million does not include annual COLA adjustments Core funding is dependent upon City Funds Sustainability next steps include including wellness center staff in Medical Administrative Activities billing through SFUSD, to continue to explore Medi-Cal reimbursements for EPSDT services, investigate leveraged funding opportunities from State and Federal sources and private foundations and increased public awareness. Consent and Confidentiality Wellness centers are located on school sites, therefore, are subject to different confidentiality law then other models. Consent and confidentiality next steps included holding trainings and, in the next school year, adopting standard forms and procedures. Initiative plans for the 2002-2003 school year include youth outreach workers, professional development, increased community awareness and comprehensive evaluation. 2002-03 DPH Efforts Depression and suicide awareness outreach (within schools and with parents) Developments of school-based behavioral health services model In summary, the wellness centers provided a platform for a variety of health education services. This could not have been possible without the support and cooperation of SFUSD, and Ms. Chan-Sew introduced Trish Bascom, the director of Health Programs at SFUSD. Ms. Bascom thanked the Commission for its support of the effort and said one of the emphases of this year is evaluation. Ms. Chan-Sew also introduced Stacy Blankenbaker, the wellness center initiative manager and the liaison between the three major partners. She introduced the wellness coordinator from Marshall High School, who emphasized that the schools are where the services need to be. Ms. Blankenbaker also introduced the coordinators from Washington High School, Lowell High School and John O’Connell High School. Jamila, a 10th grade student at John O’Connell High School conveyed that the program at the school gives students a place to go and keeps them away from other things. The nurse is good because previously they would have to go home for minor injuries and now they can be seen on site. At the wellness center students can talk to counselors about family issues without having to go through so much trouble. Commissioners’ Comments Commissioner Chow asked if other agencies work at the school site. Ms. Chan-Sew said that in addition to the RAMS and AARS staff, there are other agencies that make arrangements to provide services at different school sites. The wellness center coordinator is aware of the services provided on his or her campus, and can link the students with these services. Commissioner Umekubo congratulated staff on the great program. He asked for an explanation of the difference between the Balboa Teen Clinic and the school wellness centers. Ms. Chan-Sew said that the clinic is quite different with a full complement of direct clinical services on the school site. It is a much more expensive model. Commissioner Guy is pleased to see that this model is working. A lot of challenges had to be overcome. The next step is to stabilize funding for the current school sites. She asked Ms. Bascom how the Board of Education viewed the program. Ms. Bascom replied that the Board of Education supports this programs because it allows students to stay at school. A formal presentation has not been made by the Board of Education, although one has been presented to the joint Board of Supervisors/Board of Education Committee. Ms. Bascom is incredibly excited by this program and the one indication of success was the testimony from students at a recent Board of Supervisors’ hearing. Commissioner Chow said that this is a welcome report and pleased that the partners, including the school district, are committed to health as an educational issue. He asked what the key challenges were in terms of sustainability. Ms. Chan-Sew said that the General Fund portion of the budget has to be allocated every year. The DCYF portion is allocated as a match to the General Fund, so its allocation is hinged to the General Fund appropriation. That is why it is key to collect the evaluation data. Dr. Katz said that the wellness model is a very promising direction and has applicability not only for the school system but for all the services DPH provides. The wellness centers have enjoyed a lot of support so he believes they will be sustained. However, it might be hard to expand to program in the near future. Dr. Katz commended Ms. Chan-Sew. 7) PUBLIC COMMENTS None. 8) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) voted to hold a closed session. The Commission went into closed session at 4:20 p.m. Present in closed session were the Health Commissioners, Dr. Katz, Deputy City Attorney Ellen Shapiro, Gregg Sass and Michele Olson. C) Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Settlement on an unlitigated contractual dispute between the City and County of San Francisco and Health Management Systems, Inc., for a $550,000 payment to the City and amendment to the contract. City Attorney File No. 021180 Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) approved the settlement between the City and County of San Francisco and Health Management Systems, Inc., for a $550,000 payment to the City and amendment to the contract. D) Reconvene in Open Session The Commission reconvened in open session at 4:40 p.m. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Umekubo) voted not to disclose any discussions held in closed session. 9) CLOSED SESSION This closed session was continued to the October 1, 2002 Health Commission meeting. A) Public comments on all matters pertaining to the closed session B) Vote on whether to hold a closed session C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEES PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. OLSON D) Reconvene in Open Session Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) 10) ADJOURNMENT The meeting was adjourned at 4:41 p.m. Michele M. Olson, Executive Secretary to the Health Commission