Minutes of the Health Commission Meeting Tuesday, July 6, 2004 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 Monfredini at 3:05 p.m. Present: Commissioner Lee Ann Monfredini, Vice President Commissioner Roma P. Guy, M.S.W. Commissioner James M. Illig Commissioner David J. Sanchez, Ph.D. Commissioner John I. Umekubo, M.D. – arrived at 4:15 p.m.   Absent: Commissioner Edward A. Chow, M.D., President Commissioner Michael Penn, M.D., Ph.D. 2) APPROVAL OF THE MINUTES OF THE JUNE 1 HEALTH COMMISSION MEETING AND SPECIAL MEETING OF JUNE 29, 2004 Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez,) approved the minutes of the June 1, 2004 Health Commission meeting and the June 29, 2004 Special Health Commission meeting as amended. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sánchez chaired, and Commissioner Guy and Commissioner Illig attended, the Budget Committee meeting. (3.1) CHN-Revenue Management – Request for approval of a contract renewal with Accordis, Inc. and a new contract with Triage Consulting Group to provide retroactive submissions of Aged Accounts to Medi-Cal, Medicare, Commercial, Third Party and Workers’ Compensation Insurance payers, when recipient eligibility was not previously identified by the Community Health Network, for the period of July 1, 2004 through June 30, 2008. (3.2) CHN-SFGH – Request for approval of a retroactive contract renewal with Dobri D. Kiprov, M.D., a professional corporation d/b/a Bay Area Mobile Apheresis Program, in the amount of $300,000, to provide intermittent, as-needed, on-call mobile therapeutic apheresis dialysis services, for the period of July 1, 2004 through June 30, 2006. Commissioners’ Comments Commissioner Guy asked if, given the City’s commitment to maintain dialysis service at SFGH, it makes sense to incorporate Apheresis services into the dialysis unit. The representative from Bay Area Mobile Apherisis replied that the number of cases each year might not warrant the investment of infrastructure. (3.3) CHN-SFGH Nursing – Request for approval of retroactive contract renewals with the following firms: HRN Services, Inc., Medical Staffing Network, Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing International, in the amount of $2,700,000, to provide supplemental temporary per diem and traveling nursing personnel services for San Francisco General Hospital, for the period of July 1, 2004 through June 30, 2005. Commissioners’ Comments Commissioner Sanchez asked if SFGH is going to be able to reduce the use of registry by hiring RNs on staff. Ms. Digdigan said that the hospital is doing everything possible to hire permanent RNs, including recruiting new graduates—there are a number currently in training—sponsoring nurses from other states and countries and other efforts. It is a challenge, as SFGH competes with all other hospitals. SFGH treats its nurses well. (3.4) CHN-SFGH Radiology – Request for approval of two retroactive contract renewals with Medical Contracting Services and The Registry Network, Inc., for a combined total amount of $75,000, to provide intermittent, as-needed, professional services of per diem and traveling radiology technologists with on-call availability 7 days a week, for San Francisco General Hospital, for the period of July 1, 2004 through June 30, 2005. (3.5) CHN-Primary Care – Request for approval of a contract modification with North of Market Senior Services d/b/a Curry Senior Center, in the amount of $160,000, for the period of July 1, 2004 through June 30, 2006, to provide comprehensive primary care services for seniors in the new senior supportive housing units and a new total contract amount of $1,043,560, for the 4-year contract period of July 1, 2002 through June 30, 2006. (3.6) CHN-Primary Care-Tom Waddell Health Center – Request for approval to accept and expend a grant from the Social Security Administration, in the amount of $195,320, to extend SSI application assistance to chronically homeless and mentally ill persons in San Francisco, for the period of May 1, 2004 through April 30, 2005 and a contract with the San Francisco Bar Association’s Homeless Advocacy Project, in the amount of $156,186, for the same time period. (3.7) Central Administration–Policy and Planning – Request for approval to accept and expend FY 2004-2005 recurring grant funds from the State of California to the Department of Public Health (3.8) AIDS Office-HIV Prevention – Request for approval of the FY2004-2005 San Francisco General Fund-HIV Prevention Services contracts for a combined total of $3,711,834, for the period of July 1, 2004 through June 30, 2005 with the following agencies:   Amount with 12% Contingency Aguilas, Inc. Asian Pacific Islander Wellness Center Bay Area Young Positives Haight Ashbury Free Clinic, Inc. Larkin Street Youth Services Lavender Youth Recreation & Information Center San Francisco AIDS Foundation Stop AIDS Project Tenderloin AIDS Resource Center $   374,548 $       9,408 $     89,600 $   186,328 $   213,884 $   157,920 $1,023,557 $1,120,976 $   545,613 Total        $3,711,834 Secretary’s Note – Lavender Youth Recreation Information Center, in the amount of $157,920, was removed from the list of contracts. This contract will be forwarded at a future meeting. So the combined contract total is $3,553,914. (3.9) AIDS Office-HIV Prevention – Request for approval of the FY2004-2005 State of California Education and Prevention Grant, Counseling Testing and Referral Grant and the Corrections Initiative Grant for HIV Prevention Services contracts for a combined total of $2,109,611, for the period of July 1, 2004 through June 30, 2005 with the following agencies:     Amount with12% Contingency Black Coalition on AIDS $  161,805 Centerforce, Inc. $  224,459 Continuum HIV Day Services $  185,848 Haight Ashbury Free Clinic, Inc. $  492,087 Harm Reduction Coalition $  176,217 Iris Center $  237,593 Regents of the University of California, UCSF – AIDS Health Project $  575,602 Regents of the University of California, UCSF – Stonewall Project (Six Months) $    56,000  Total $2,109,611 Commissioner Sanchez abstained from voting on this item as it pertains to the UCSF contracts. (3.10) AIDS Office-Prevention Services – Request for approval of a contract renewal with UCSF/ Urban Health Study, in the amount of $272,759, to provide HIV prevention services targeting defined behavioral risk populations, for the period of July 1, 2004 through December 31, 2004. Commissioner Sanchez abstained from voting on this item. (3.11) AIDS Office-Prevention Services – Request for approval of a retroactive contract renewal with the Regents of the University of California/UCSF/Positive Health Practice, in the amount of $158,556, to provide Peer Advocacy, Case Management, Social Work Case Management, Nutrition Counseling and Treatment Advocacy services through the Men of Color Program, for the period of September 30, 2003 through September 29, 2004. Commissioner Sanchez abstained from voting on this item. (3.12) AIDS Office-HIV Health Services – Request for approval for contract modifications to extend the term for an additional year for five FY 2004-2005 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title I contracts, for a total of $2,831,322, for the period of March 1, 2005 through February 28, 2006. The two year combined total for the period of March 1, 2004 through February 28, 2006 for these contracts will be $5,645,885, with the following agencies:   Contractor   FY 04/05 Amount Modification Amount FY 05/06 Two-Year Amount Maitri AIDS Hospice   $ 184,352 $ 201,111 $ 385,463 Maitri AIDS Hospice   $ 906,330 $ 906,330 $1,812,660 Project Open Hand   $1,231,281 $1,231,281 $2,462,562 Shanti Project   $ 341,600 $ 341,600 $ 683,200 UCSF-AIDS Health Project   $ 151,000 $ 151,000 $ 302,000 Total   $2,831,322 $2,831,322 $5,645,885 Commissioner Sanchez abstained from voting on this item as it pertains to the UCSF-AIDS Health Project. Commissioner Illig abstained from voting on this item as it pertains to Project Open Hand. (3.13) AIDS Office – Request for approval to accept retroactively and expend Year-Two grant funds from the Substance Abuse and Mental Health Services Administration, in the amount of $487,805, of which $475,522 is a sole source contract with UCSF AIDS Health Project, for the period of June 1, 2004 to May 30, 2005. Commissioner Sanchez abstained from voting on this item. (3.14) PHP-Housing and Urban Health – Request for approval of contract renewals for fourteen FY 2004-2005 Housing and Urban Health contracts for a combined total of $12,595,689 as follows:   Contractor Contract Term Contract Amount (Including Contingency) Ark of Refuge, Inc. 7/1/04-6/30/06 $ 896,000 Baker Places, Inc. 7/1/04-6/30/07 $ 1,993,895 Baker Places, Inc. 3/1/04-6/30/05 $ 544,570 Baker Places, Inc. 7/1/04-6/30/05 $ 1,381,299 Episcopal Community Services 7/1/04-6/30/06 $ 2,720,575 Homeless Children's Network 7/1/04-6/30/06 $ 63,108 John Stewart Company 7/1/04-6/30/06 $ 1,848,143 Lutheran Social Services 7/1/04-9/29/05 $ 168,137 Lutheran Social Services 7/1/04-6/30/07 $ 453,284 Mercy Housing Corporation 7/1/04-6/30/05 $ 236,299 Page Street Guest House 7/1/04-6/30/05 $ 957,842 San Francisco AIDS Foundation 7/1/04-6/30/06 $ 521,035 Self-Help for the Elderly 7/1/04-6/30/06 $ 262,703 Tenderloin Neighborhood Development Corporation 3/1/04-6/30/05 $ 548,800 Total   $12,595,689 (3.15) BHS-Mental Health – Request for approval to renew the cooperative program agreement with the Department of Rehabilitation, San Francisco District, in the amount of $972,670, to provide vocational and employment assistance services for mentally ill clients for the period of July 1, 2004 to June 30, 2007; a contract with Community Vocational Enterprises, in the amount of $467,832 and a contract with Richmond Area Multi-Services, in the amount of $504,838, for the period of July 1, 2004 through June 30, 2005. (3.16) BHS-Mental Health – Request for approval to accept and expend a federal McKinney PATH grant in the amount of $423,964, to expand homeless services for the period of July 1, 2004 to June 30, 2005, and a contract with Swords to Plowshares in the amount of $92,325; with Curry Senior Center in the amount of $20,000; and with San Francisco Study Center, in the amount of $52,315, for the same time period. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez,) approved Items 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.14, 3.15 and 3.16 of the Budget Committee Consent Calendar. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved Items 3.9, 3.10, 3.11, 3.12 and 3.13 of the Budget Committee Consent Calendar. Commissioner Illig abstained from Item 3.12 as it pertains to Project Open Hand. Commissioner Sanchez abstained from Items 3.9 (as it pertains to UCSF), 3.10, 3.11, 3.12 (as it pertains to UCSF) and 3.13. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Action by the Budget Committee The Budget Committee completed its deliberations late last Friday night. After accepting $583,000 in reductions recommended by the Budget Analyst, the Committee restored $8.3 million in General Fund to Public Health, comprising $11 million in expenditures offset by $2.7 million in revenues. Restorations included all those programs that the Health Commission designated as highest priority to restore if money were available. Specifically, the Committee restored $1.7 million in Primary Care services, $1.7 million to backfill Ryan White CARE Act cuts, and $925,000 for AIDS emotional and practical support programs. Other restorations included the SFGH Dialysis Clinic, Team 2 and Southeast Mission Geriatric at the current locations, interpreter services at SFGH, social work managers, Mt. St. Joseph’s Epiphany Center, and elimination of the pharmacy co-pay. The Committee also partially restored the DEAP program and cuts to Primary Care administration. The Budget Committee accepted a proposal crafted by Jail Health Services and their labor partners to reduce Jail Heath expenditures by $3.0 million as a replacement for the Mayor’s proposal to outsource the services for an estimated savings of $4.5 million. As part of the agreement, a Blue Ribbon Committee will be established to study the provision of Jail Health Services and make recommendations for future years’ budgets. The Budget Committee recommendations will be forwarded to the full Board for action. As proposed, the Department shall sustain a $20.2 million reduction to its General Fund, but will avoid potentially serious service cuts. Ten Year Homeless Plan On June 30th, the City unveiled a new plan entitled "The San Francisco Plan To Abolish Chronic Homelessness." San Francisco became the 121st city in the country to develop such a "ten year plan," a movement that is being promoted by the National Alliance to End Homelessness and the Federal Government through the U.S. Interagency Council on Homelessness. Most notably, San Francisco's plan calls for the development of 3,000 supportive housing beds based on the "Housing First" principle. The Housing First model includes placing chronically homeless people directly off the street into housing and then actively engaging residents to promote stability and improved health and well-being. The planning process was chaired by former Supervisor Angela Alioto and included 33 community members representing a broad cross section of San Francisco. SFGHMC Opening Its New Mental Health Rehabilitation Center (MHRC) Last week, San Francisco General Hospital was awarded licensure for its Mental Health Rehabilitation Center (MHRC) by the California Department of Mental Health. Mental health rehabilitation centers provide intensive support and rehabilitation to clients as an alternative to state hospital or other 24-hour care facilities. MHRCs focus on psychosocial rehabilitation of clients with severe and persistent mental illness and allow for seclusion and restraint, if needed, to address behaviorally complex patients. The creation of the MHRC is one of the recommendations by the Mayor’s Mental Health Rehabilitation Facility (MHRF) Blue Ribbon Committee and will serve as a means to address the diverse medical, rehabilitative and housing needs of the current MHRF residents and mental health patients in the City. The 47-bed MHRC, located on the 3rd floor of the MHRF Building, opened today. San Francisco General Hospital Recognized for its Model Policies and Procedures for Language Access San Francisco General Hospital has been selected by the California Association of Public Hospital’s Safety Net Institute to serve as a Reviewer Hospital for the Institute’s Model Hospital Policies and Procedures for Language Access initiative. SFGH was chosen based on its efforts to better serve Limited English Proficient patients. The Reviewer Hospital selection comes with a $10,000 stipend from the California Endowment to support language services. “Good Doctors” Dr. Kevin Grumbach, Chief of Family and Community Medicine at SFGH, was one of three physicians who were highlighted in the Sunday, July 4th issue of San Francisco Chronicle Magazine, as “Good Doctors” who embody the Hippocratic oath. As described in the article, Dr. Grumbach, in addition to seeing patients at SFGH, is a leading proponent of a national single payer system for the United States. DPH is proud of Dr. Grumbach and share in this celebration of his work. National Association of Public Hospitals and Health Systems Gene O’Connell has been named to serve on the 16-member Executive Committee of the National Association of Public Hospitals and Health Systems (NAPH). She has been elected to a two-year term effective July 1, 2004 through June 30, 2006. Congratulation to Ms. O’Connell on her new role with this important national public health advocacy and research organization. Robert Okin, MD; Alicia Boccellari, PhD; Vanessa Kelly, Psy.D.; and Greg Merrill, LCSW are winners of the 2004 NAPH Safety Net Awards in the Community and Patient Service category for the Trauma Recovery Center project. The Trauma Recovery Center is a 4-year demonstration project to help remove barriers to care and to increase access to mental health and clinical case management services to victims of interpersonal violence (i.e., domestic violence, sexual assaults, gun shot injuries, stabbing, etc.). The Community and Patient Service Category of the NAPH Safety Net Awards program recognizes employees and faculty in member hospitals and health systems who have designed and implemented creative and successful programs that improve care for cultural and linguistic minorities, address disparities in health care or health outcomes; or improve patient satisfaction. Commissioners’ Comments Commissioner Illig asked how the $1.7 million that the Board of Supervisors allocated to backfill the reduction in Ryan White funds was prioritized, as the reduction was $4 million. Dr. Katz replied that the overall reduction included cuts to Marin and San Mateo Counties, as well as DPH Administration. These were not restored. Some services and/or organizations were not backfilled for a variety of reasons, including the inability to sustain themselves through the budget process, not meeting units of service, the cost of units of service was much higher than average, or there was a parallel program funded through General Fund. Additionally, higher targets were set for Medi-Cal billing. Commissioner Illig asked for clarification that the list was generated by DPH, rather than the HIV Planning Council. Commissioner Guy asked that each Joint Conference Committee evaluate the impact of the budget cuts. A new Strategic Plan is being developed, and it needs to be determined if there is a qualitative change in the Department’s capacity, due to decreasing General Fund, that necessitates changes in the Strategic Plan. She asked if we know what impact the budget is going to have on Laguna Honda Hospital. Dr. Katz replied that the full extent of the impacts could not be determined until the Fall, because the layoffs are not effective until September 1. He reminded the Commission that the base budget fixed a number of structural problems. Commissioner Guy asked who in the Department would be the point person on responding to the Grand Jury report on the EMS merger. Commissioner Guy’s hope is that the Commission could develop preliminary recommendations. The Commission has asked for this level of input and dialogue with the Fire Commission. Commissioner Sanchez said that had it not been for the participation of thousands of San Franciscans in the budget process, the funds would not have been restored. Even with the restorations, the Department continues to operate at reduced capacity due to past budget cuts, so the dialogue needs to continue. Commissioner Monfredini attended two Board of Supervisors’ committee meetings, one on Charity Care and one on patient flow between SFGH and LHH, and asked Dr. Katz’s for his assessment. Dr. Katz said the Charity Care Report was well received by the Board, and there was a stated commitment by hospitals to increase charity care. The patient flow hearing was difficult. There is not an easy answer in terms of balancing needs of long-term care patients with different needs. Dr. Katz will be attending a meeting with the Medical Staff on Thursday, and remains hopeful. Commissioner Monfredini thanked Commissioner Illig and Commissioner Umekubo for representing the Health Commission at the Patient Flow hearing, and Commissioner Guy for attending the Board’s Budget Committee meeting. She thanked Dr. Katz for his hard work, forthrightness and advocacy during these difficult times. 5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF JUNE Commissioner Illig presented the Employee Recognition Awards for June.   Individual Awardee Division Nominated by Jeanette Guerrero, Health Worker Community Behavioral Health Services Karen Acosta, Nurse Manager, and the MOST Team of South of Market Team Awardees Division Nominated by Gun Violence Prevention, Community Programs Sai-Ling Chan-Sew, Response and Recovery Team Assistant Director Janice Avery Cynthia Billups   Dionne Carter Wanetta Davis   Yul Dorn Esperanza Echavarri   La Donnis Elston Rochelle Frank   Cati Okorie Karen Pierce   Lynice Pinkard Roban San Miguel   Cynthia Selmar Kevin Smith   Calvin Thomas Hansel Tomaneng   Lina Weissman Lynn Westry   6) MATERNAL AND CHILD HEALTH REPORT Mildred Crear, MCH Director, Maternal Child Health and Philip Ziring, M.D., Medical Consultant to MCH, presented an update on the Maternal Child Health Program. The presentation included an overview of MCH’s goals and objectives as they relate to the DPH Strategic Plan. The presentation focused on collaboration and integration, both within DPH and externally. MCH collaborates with myriad DPH services, including the AIDS Office, WIC, Immunization, STD Prevention and Control and Family Planning, just to name a few. Integration is carried out by: Pre-planning with managers within MCH and managers at the agency/organization etc. Development of mutual goals and objectives Ongoing communication between MCH management and agency/ organization/worksite managers Support MCH out-stationed staff to ensure integration into the new worksite Conduct ongoing joint evaluation Build in mutual problem solving Collaboration is carried out through staff consultation and technical assistance, systems connections, facilitating access, monitoring quality of service, training, referrals, outreach and service delivery. Dr. Ziring gave an overview of the health programs in the San Francisco Unified School District. These programs reach 60,000 students in 160 schools where 50 languages are spoken. There are 28 nurses in the School Health Program, and almost all are grant funded. MCH provided school health consultation services, including dental and hearing screening, physical and occupational therapy and nutrition education. Emerging Opportunities for Collaboration Closer linkage of Wellness Centers with DPH programs (i.e. Balboa Clinic, STD Prevention, child care and foster care); Closer linkage with physicians in the community; Pediatrics Advisory Committee to MCH; Transition services from early intervention through high school graduation for children with disabilities; Pediatrics Residency Training in Public Health; Links between television, violence and obesity. Planned Opportunities for Collaboration Parochial Schools Independent Schools Ms. Crear discussed the ways through which MCH focuses on quality family-centered care. MCH incorporates family centered care into program operations. Family-centered care activities have included hiring parent advocate to serve as family/staff liaison and supporting the Family Centered Care Committee, which is composed of parents, staff and community representatives. Commissioners’ Comments Commissioner Illig asked if MCH connects children to Healthy Families. Ms. Crear replied that the School District is a Healthy Families partner and is primarily responsible for connecting children to the program. DPH, through the Bringing Up Healthy Kids Coalition, provides training and other services to the School District for this connection. Commissioner Illig asked if most children have primary care physicians. Dr. Ziring replied that most students are supposed to have a primary care physician, but most students could not tell you the name. This is something everyone is focused on, since research clearly shows that there are better health outcomes when people are linked to specific physicians. Commissioner Guy said the Commission and MCH have been working through the Population Health and Prevention Joint Conference Committee over the past few years toward integration with other child-serving programs. It is important for the Commission to understand what strategically it should be advocating for—more nurses, more health centers, or other initiatives. Commissioner Guy asked if MCH provides dental sealants to children. Ms. Crear said that MCH has a dentist that provides sealants to second grade students. Commissioner Monfredini urged Ms. Crear to communicate the MCH priorities to the Health Commission. 7) PRESENTATION OF THE YOUTH DEVELOPMENT POLICY AND CONSIDERATION OF POLICY ADOPTION Iman Nazeeri-Simmons, MPH, Adolescent Health Coordinator and Christina Carpenter, MPH, Community Health Education Section, presented the Youth Development Standards for Practice for the Department of Public Health. The goals of the Standards of Practice are to promote a common understanding of youth development and to establish a consistent set of standards for practice and to ensure that young people acquire the skills and support they need to become healthy adults. It is a quality improvement strategy for youth-serving programs. Youth Development is an approach that should be at the core of all youth service programs. It is not a program. Examples of youth development in action are: Youth Advisors/Board members Adult mentors for youth Youth stipends/incentives Fun, youth-inspired spaces Mutual respect between adults and youth Youth greeters Youth advocating to improve recreation facilities Programs include youth/family nights Youth are both leaders and participants Youth develop and evaluate programs. The Standards of Practice Policy consists of guiding principles; organizational structure, culture and environment; programmatic structure, youth participation and skill building; community and family connections; and training, evaluation and monitoring. Staff met with numerous groups, both internal and external to DPH, while developing the proposed policy, including the School District, Mayor’s Office of Criminal Justice, Juvenile Probation, community-based organizations and youth focus groups. There are a number of DPH programs that put youth development into action, including Primary Care’s Community Health Programs for Youth (CHPY), STD Prevention and Control’s Youth United Through Health Education, the Children’s System of Care Youth Task Force, YouthPOWER and the Health Commission/Office of Adolescent Health Youth Health Advisor. Implementation Plan Case study drafted and list of resources compiled Training curriculum to be developed with Community Network for Youth Development and Health Initiatives for Youth Youth will be involved with training and evaluation Trainings will first be held for DPH staff and then for contractors. Public Comment Michael Baxter, Director of Community Health Programs for Youth, which includes Balboa Clinic, Hip Hop Clinic, Cole Street Clinic and Larkin Street Clinic. Balboa Clinic will have a Youth Advisory Board. The State should push youth development as a policy and should fund these initiatives. Sue Eldredge, Community Network for Youth Development, said the organization has been working with DPH staff over the last three years to shape this policy. This is a model policy for other City departments and throughout the country. Victor Damian, Youth Coordinator for Children’s System of Care Youth Task Force, said that youth development works. He runs a program for youthwho are involved in mental health, foster care and criminal justice systems. Young people are the experts for these systems so they should have input in the programs. He asked that the Youth Task Force has further dialogue with the Commission. Rosemarie Menses, Youth Task Force, said youth who have been through the hardest experiences have benefited from youth development and she stands as an advocate. Cloteal Norman, Youth Task Force member, she has really seen a change in the way the Task Force is viewed by adults. Before, adults did not know what young people had to offer. Now that has changed. The program has helped her become a better leader, stay in school. Sharon Dolan, Health Initiatives for Youth, said this policy represents the intersection between health and youth development. Ann Song, Health Education Specialist with Contra Costa County, and a recent intern at DPH Office of Adolescent Health, said youth serving agencies in San Francisco really rallied around the youth development policy. Stephanie Champion, San Francisco Youth Commission, fully supports the youth development policy. It is an important step to helping youth be independent and engaging members of society. Adreena Winfield, Youth Power, said that her organization’s goal is to stop alcohol and drug abuse in the Bayview Hunters Point Community. The staff of her program treats the youth with respect. Etan Zaitsu, Youth Power, said that youth development allows connections with young people, opportunities for leadership. Young people have fresh perspectives and creative ideas. Erica Newport, Youth Health Advisor to the PHP JCC, said she is a product of youth development. When she is at the PHP JCC meetings, she is a part of the decision-making, rather than just a product of adult decision-making, and this is a tremendous experience. Commissioners’ Comments Commissioner Guy said this is a primary prevention approach, and she is pleased that the policy is before the Commission. The Joint Conference Committees will follow-up on training and implementation. This should be a key component in the revised Strategic Plan. Commissioner Illig said that the policy makes a lot of sense for youth-focused programs, and asked if this could be applied to programs that serve primarily adults, but also youth. Ms. Carpenter said that these are applicable concepts. Ms. Carpenter reiterated that the policy is not meant to be punitive, but to really raise the level of service. Commissioner Sanchez commended the policy. Commissioner Monfredini referred Victor Damien’s request to the PHP JCC. Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) adopted the Department of Public Health Youth Development Standards of Practice (Attachment A). 8) PUBLIC COMMENT None 9) CLOSED SESSION: Public comments on all matters pertaining to the closed session None.   Vote on whether to hold a closed session (San Francisco Administrative Code Section 67.11) Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) voted to go into closed session. The Commission went into closed session at 5:30 p.m. Present in closed session were Commissioner Guy, Commissioner Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner Umekubo, Laurene Bourey, R.N., Risk Management Nurse, Blake Loebs, Deputy City Attorney, Mitch Katz, Director of Health, Gene O’Connell, SFGH Executive Administrator, Hiroshi Tokubo, Risk Management and Michele Olson, Health Commission Executive Secretary.   Closed session pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.10(d) Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) approved the settlement in the amount of $240,000 in the Jean B. Applebaum et al vs. City and County of San Francisco, Superior Court File Case #410-962.   Reconvene in Open Session The Commission reconvened in open session at 5:57 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 item) Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Umekubo) voted not to disclose any discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 5:58 p.m. Michele M. Olson, Executive Secretary to the Health Commission