Public Health Committee (PHC) Meeting Transcript – 12/4/2024 Title: ATXN-1 (24hr) Channel: 1 - ATXN-1 Recorded On: 12/4/2024 6:00:00AM Original Air Date: 12/4/2024 Transcript Generated by SnapStream ================================== Please note that the following transcript is for reference purposes and does not constitute the official record of actions taken during the meeting. For the official record of actions of the meeting, please refer to the Approved Minutes. [10:02:08 AM] >> Hi everyone. Good morning. I call to order this meeting of the Austin city council public health committee. The time is 10:02 A.M. On Wednesday, December fourth, 2024, and we are in the city hall chambers. Welcome everyone to our December public health committee meeting. This is our last meeting of the year, if you can believe it. It's just gone by. So fast. We are joined today by our vice chair, councilmember Jose Velasquez, as well as councilmember Ryan alter, who are members of the committee. So we have a few items on our agenda, and our goal is to wrap up by noon. So we'll start with public communications. Then we'll move to approving the meeting minutes from November 6th. And from there the committee will then head into executive session to take up personnel matters related to the central health board of directors. When we return, we will discuss the appointment recommendations to the central health board of managers, and then we'll discuss and take possible action and [10:03:10 AM] possible action and recommendations regarding the echo's state of the homelessness response system report and gaps and investments to improve the system. Finally, we'll move into our briefings from there. The first briefing we'll have will be on central health and its housing for health partnership, providing respite care and services program for unhoused community members. And last but not least, we will hear from our homelessness strategy office for an update on the city's marshaling yard, which is serving as emergency shelter right now. Are there any questions or comments on the agenda? Okay. Thank you. We'll now move to speakers from the community. Do we have any registered. Good morning chair. >> No, there are no speakers this morning. >> All right. Thank you. And now we'll move to approval of the meeting minutes from November 6th. Can I have a motion moved by vice chair Velazquez, seconded by councilmember Ryan alter. Any objection to approving the meeting? Minutes from November? Seeing none, those stand approved. And now we'll move on to item two. [10:04:11 AM] we'll move on to item two. Discussion and possible action on appointment to the central health board of managers. I'd like to pause on this item and take it into executive session. And so the committee will now go into closed session to take up one item pursuant to section 551.074 of the government code. The committee will discuss personnel matters related to item number six, discuss the selection of members to the central health board of managers. Is there any objection to us going into executive session on the item announced hearing none. The committee will now go into executive session. We are out of closed session and [10:42:27 AM] We are out of closed session and closed session. We discuss personnel matters related to item number six and believe now we have a recommendation from vice chair Velazquez to move forward with the reappointment of amit motwani, as well as doctor Cynthia Brinson, to the central health board of managers, seconded by councilmember Ryan alter. Any objection? Seeing none, we will now move forward with those recommendations to the full councilat our next council meeting and again, that is for the reappointment of Cynthia Brinson and amit motwani to the central health board of managers. Thank you. All right, colleagues, we will now move on to our next item discussion and possible action regarding echo state of the homelessness response system report and recommendations and additional investments to fill comprehensive gaps. Colleagues. Last month, we received a [10:43:28 AM] Last month, we received a presentation from echo around the current state of homelessness response and the presentation highlighted a number of needs that we have, including approximately 350 million needed to sufficiently address our homelessness response system over the next ten years. As a committee, we are tasked with making policy recommendations and decisions regarding homelessness. And so I am bringing forward a committee recommendation to prioritize investments in our homelessness response system. You should have a yellow copy of that policy recommendation before you. Essentially, this recommendation adopts echo's report as a model to inform investments in the homelessness response system and makes adjustments in response to the updated data. It also directs the city manager to explore additional funding opportunities for us and to prioritize those ongoing investments in the homelessness response system, starting with [10:44:28 AM] response system, starting with fiscal year 2526. And this is key here. We really want to ensure that we make our homelessness response system one of our top budget priorities going into next fiscal year. It also directs the city manager to identify policy and administrative changes necessary to complete our psh units. And I think that is part of the amendment that councilmember Ryan alter has before us. And this includes a report back date. And so we have that. We have my recommendation. I move my recommendation if I can have a second council vice chair. Velazquez seconded seconds the recommendation and then councilmember Ryan alter, I believe you have an amendment to the recommendation. >> I do thank you very much. And yeah, this this is to build on what the chair was talking about, adding a couple things to identify. First and foremost, [10:45:29 AM] identify. First and foremost, the arpa cliff that is coming and really understanding what programs that we have been operating via arpa dollars. Do we think we should continue to operate? And if so, how are we going to fund those in the upcoming budget, as well as one of the big cost drivers in the echo report, is the need for over 4000 units of permanent supportive housing. And if that is something that we are going to provide as a community, as a city and hopefully with partners, we are going to need a large amount of capital and a large amount of ongoing funding for those services. And so these projects take a long time. They're not something that, you know, in 2027, we can say we want to start the process to get units in 2028, we need to start the process today. If we're going to be building the over [10:46:30 AM] going to be building the over 600 units in some of these years, that is called for in this plan. And so the hope is for the manager homeless strategy office, the housing department to put forward a here's how we would accomplish that goal type plan. You know, here are the capital dollars we would need. Here's the timeline. Here are the operational dollars we need. And this is how we would do it if that is the goal. So I just want to make sure we get we have enough lead time to accomplish the goals within this model that are so important. And so I think that's a really critical add. The final thing that we want to explore is when we talk about in the report capacity expansion, capacity isn't always just adding additional beds. Right. And when it comes to shelter or other interventions, you can bring another bed online or you can [10:47:31 AM] another bed online or you can get the person who's in the bed into housing. And that has the same effect. And so how can we figure out ways to increase turnover, increase moves to housing that has the effect of adding capacity but doesn't require that additional capital expense. And has the outcome that we're trying to get. So that is what my amendment adds on to the chair's item. And I really appreciate her bringing this forward to make this a priority. You know, we've seen the you prioritize it in the last budget and appreciated that work. And so now look forward to continuing to do that in the upcoming budget. >> Thank you. Any objection to incorporating council member Ryan alter's amendment seeing none, the motion stands amended and any discussion on the motion to move forward, this recommendation. Okay, any [10:48:31 AM] recommendation. Okay, any objection to moving forward? The recommendation? All right. Seeing none, the recommendation stands adopted colleagues. This recommendation will go to the full council for consideration. I want to thank you for your support on this. I think it means a lot that our public health committee has taken a deep dive into our homelessness response system, and so I appreciate all the work and support from our city staff, especially from the leadership from David gray, our chief homelessness strategy officer. And we'll have this discussion as a council. My suggestion to the city manager would be that we consider this at the January council meeting, and it can be one of our top focus as we begin 2025. All right. Thank you. So we'll now move forward on our next item. This is a receive an update from central health on its housing for health partnership, providing respite [10:49:32 AM] partnership, providing respite care and services program for unhoused community members. I want to welcome doctor pat Lee, Perla Cavazos, Monica Crowley, doctor Cynthia Brinson and amit motwani from central health for an update on this housing for health partnership. Thank you all for being here. >> Good morning council members. Thank you. Chair. My name is Perla Cavazos. I'm the deputy administrator at central health, and I'm going to kick off our presentation today. I want to again thank you for the opportunity to give you some updates about central health, including our services and initiatives around serving people experiencing homelessness. Our presentation today, what we're going to do, just to give you an overview, is we're going to talk a little about our accomplishments in fiscal year 2024. We're now in fiscal year 2025. So we're going to share a [10:50:32 AM] 2025. So we're going to share a little bit about our priorities for the upcoming year. And then we also want to give you an overview of some of our programs and initiatives serving people experiencing homelessness. I want to recognize our board of managers that are here today. Of course, doctor Cynthia Brinson, amit motwani is also here. I want to acknowledge a manager, Cynthia Valadez, who's here, and I also want to recognize other city appointed board managers who are Elisa may, doctor Manuel martin and marama. Thank you for appointing these leaders to our board of managers. I'm going to hand it over to amit motwani and Cynthia Brinson to say a few words before we hand it over to doctor pat LI to begin the formal presentation. >> Thank you for having me, [10:51:41 AM] >> Thank you for having me, chair and council members. My name is amit motwani and I have served on the central health board of managers for the last four years, and I have a background in nonprofit health and human services for about the last 20, 25 years here in the Austin area. And a strong, in my opinion, understanding of how the health system affects folks uniquely through the lens of social health determinants or non-medical drivers of health. One of those, of course, being income, and how poverty affects poverty and stressors, and of course, sociocultural and racial issues can affect health outcomes in our community. And that's what drives me to be on this board. I'm a former map member and a former community care patient myself, and so it is very personal to me. This mission that we share to ensure that all folks in Austin have access to high quality health care and access to the same probability of positive health [10:52:43 AM] probability of positive health outcomes, which has not been historically the case. One of the things that has been uniquely heartening for me recently is to see the enterprise, the central health enterprise, progress when it comes to standing up respite care services in just a very short period of time. And I'm bringing this up because this is representative and emblematic, I should say, of the collaboration of the city and the county and the health care district, the hospital district, around providing care for those who need it most, both by means of a moral imperative, but also by means of pragmatic imperative. And so folks who are experiencing homelessness need the time and space to be able to heal. Not only do they need the access to care, which is of course, what we tirelessly work to provide, but the time and space to be able to heal off the streets and for one thing that's uniquely notable, I think, is that we were just recently [10:53:44 AM] that we were just recently reported back to you from our CEO that we've doubled effectively our goal, our base goal of around 3400 respite bed days. And it's, I believe, over 6700 in the last year. And so that's something that I'm extremely proud to share as a board manager in the benefit and hard work that our CEO and staff have been guiding. So in the interest of time, I'm going to spare you all the other 15 things that really inspire me about this work. And I thank you all for your support, attention and hard work. And of course, the support and appointment. >> Thank you Perla and manager motwani for that lovely opening and colleagues, it's an honor to be here, friends. Thank you so much for the opportunity to [10:54:44 AM] much for the opportunity to address you. I just want to acknowledge and thank our colleagues in the in the audience acm hayden-howard David gray, Sharonda Williams and others. It's really an honor to be here with all of you. So what I'd like to begin is, is, is really the place that we begin with. Every new employee orientation and many of the all employee gatherings that we have, which is with the statement of belief that we believe at central health, that we are strongest when we are one trunk. Many branches, when we're clear about the trunk, why are we here? What is our purpose? What are our core values? And we lift up the many branches. What is the diversity that nourishes this trunk? And it's held up by the trunk. So on the right you see that our trunk begins with trust. We believe that our work is to earn trust, period. And through trust, we then can have a real conversation about whole [10:55:45 AM] a real conversation about whole person care. What is it that a person before us needs to thrive? All of it. Medical care, surgical care, behavioral health, substitutes care, nutrition, transportation, housing, education and so on. What does that look like for you today and tomorrow? Because the work and the journey doesn't stop when we leave this conversation. We want to do that at scale for everyone who needs us in our community. Not one size fits all, but one size fits one, because it's likely different for each of us and may be different for us at different points in time. And if we can do that, of course, easier said than done, then we believe that leads to the outcomes that matter, which is how we think about health equity. These are the quadruple aim outcomes. Aim number one is the care kind and compassionate as we'd want for our own mothers and sisters and loved ones. Number two is the care high quality? Does it directly address the reasons why people are dying 10 to 20 years [10:56:46 AM] people are dying 10 to 20 years before their natural time? Predominantly black and brown neighbors, predominantly in the east side? Are we getting right at the root of that and impacting that unjust life expectancy gap? Number three, is that high value care? What benefit are we getting for the public dollars that we are investing into this space? Are we investing in the right things? Are we making both near-term and long term investments here? Very much appreciate. Council member alter's commentary about the foresight that's required to really build to the gaps that exist in the space. And number four, is this work that is thriving. This is hard work. We've always known that. We learned that more through covid. So can we sustain a sense of family, a sense of fulfillment, a sense of thriving for our current workforce and the future workforce? Folks who are coming up through the Austin community college, or aid so that there are good jobs with good benefits [10:57:46 AM] are good jobs with good benefits in our community impacting the economics of our community. And through all the circles and communities that those individuals come and live in, the branches that nourish this trunk, the first branch is the people and culture, which will always be the first branch. As long as I have the privilege of serving in this role. The second is community health DNA. We are the only hospital district in a major public urban area in Texas that does not currently own and operate the hospital, and for 20 years we have worked in community, we've worked through partnerships, we've worked through hundreds of contracts with hundreds of partners. And that I think, is a feature and not a defect in my view, that enables us to see the whole care continuum, to see the entire space that patients move through across these often complicated and fragmented journeys and we think that is necessary, actually, to build the health system of the future that our community deserves and that our country deserves as a branch [10:58:47 AM] country deserves as a branch number three is the financial strength and flexibility the privilege and the trust of the people of Travis county to allow us to have a revenue source that grows as the prosperity of our community grows and allow us to channel that prosperity into the full breadth of whole person care that our community and our patients need. That is a remarkable legislative. Structure that is not replicated around the country and is part of the secret sauce that allows our hospitals to be as effective as they are. The north star for us is the seven year health care equity plan. This, as you know, is a seven year, over $700 million investment to close a directly defined and measured gaps that we have identified that if you imagine there are islands of care, there's islands of good care in our community, but those islands are separated [10:59:47 AM] but those islands are separated by deep running water. And we often ask our patients to swim across that water, and they're not equipped to swim those deep channels on their own. They wash up again on the shores of this island that they have been on in the emergency department picked up for a misdemeanor in jail, may be incompetent to stand trial. And on our streets. And until they they die 10 to 20 or even 25 years earlier than their natural time. We can't expect the private sector to build the bridges between those islands. We can't expect a nonprofit to invest $700 million over seven years. This is the role of local government. It is our privilege. It is our responsibility, and we are honored to be on that journey. The next branch is our central health family, our central health system, central health community care center. We have the honor of being part of the public health system of Travis county. Each component of this system plays a unique role. Central health provides the [11:00:49 AM] Central health provides the umbrella, the revenue source, the connective tissue, the specialty care, the transitions of care, the ability to make these deeper structural investments. Community care is the primary care heartbeat of this system. Primary care is central to any patient journey through the population that must be strong. Sendero provides the ability for us to flexibly and innovatively align the incentives, the financial incentives for how patient care is provided, and also draw down innovative funding through the national ACA marketplace. Partnerships are absolutely required to make this go. The city is central to it. We thank you for your leadership and your vision and your focus and dedication on housing for health, amongst other vital priorities. The county integral care, UT, our community and many others are absolutely central. This, this, this works with many hands, not with one. And ultimately, we want to make sure that we're speaking to the [11:01:50 AM] that we're speaking to the heart. We're talking about people and the impact of our work in terms that really matter and resonate. Dollars and data are valued, valuable and important. But ultimately we need to speak to the heart. So I want to briefly just describe some of the key points from last fiscal year. I'll start here with access and enrollment. These are numbers across map and map basic from fiscal year 2020 to the most recent year in 2024. There was a bit of a declination during the early part of the pandemic, but you can see that overall, we've risen by about 36%, or about 22,600 individuals during that period of time, most of it through the map. Basic part of our work the map as you as you are aware, requires alignment across our partners, including ascension, Seton. But map basic we are able to move more independently and meet people where they are. This is a [11:02:52 AM] people where they are. This is a busy slide, but it is a what we use is sort of a red yellow green dashboard of the key work in year one of that health care equity plan from last year. What I will share with you is that prior to last fiscal year, this entire slide would have been red. And now you can see that it's not entirely green, but there is a tremendous amount of work on this page. We are not the central health that we were 20 years ago. We are not the central health that we were three years ago. We are directly following the lead of our hospital district colleagues in Dallas and Houston and San Antonio and elsewhere, to stand up and build the safety net system that closes the gaps between those islands of care. We haven't seen any other way, really, to provide that care continuum. If we don't step forward and build to the gaps that exist on the left hand side, you see at the top three new [11:03:54 AM] you see at the top three new facilities, and I'll show that geographically in a moment that were stood up and two more that are in process, a large navigation center to connect some of these dots that map eligibility to make it easier, which we cannot move without. Ascension's agreement, completing the Mesa's performance review and a great deal of connective tissue work working with the jail colleagues on the streets. There'll be more details to come. Transitions of care, skilled nursing facilities, home based services, respite services, cancer screening, working with integral partners and with the county's diversion mental health pilot. And on the right you see a whole suite of medical specialties and diagnostic services. Standing up. A couple or three of these in a year is already fairly significant for typical health system to stand this entire amount really, really is a testament to the dedication and ability of our teams, and I'm deeply honored to serve with an organization that has been able [11:04:55 AM] organization that has been able to do this with a mission focus. I want to give you just one brief sense of what this means. So in this list of services, you see podiatry and x-ray. There was a week in March where both services went live together. And at the end of that week, on a Friday afternoon, an 86 year old el salvadoran woman presented for care with severe foot pain and the podiatrist saw her. Doctor, Brett vessel, was worried about a serious infection and was able to take an X ray immediately on site. That X ray demonstrated gas bubbles in the soft tissue of her foot. That clinically signifies a potentially life threatening gangrene infection. This is a Friday afternoon, but because we were able to control this care continuum, we could immediately escalate to definitive care. In the end, that woman had one toe amputated and the appropriate antibiotics. We saved her foot. We saved her life. Had that not happened on that Friday afternoon, we had to [11:05:55 AM] that Friday afternoon, we had to Monday. She almost certainly would have lost that limb if it waited to Wednesday. That infection might have gone to the blood with overwhelming sepsis. She might have lost her life. How many people in our community have lost their limbs without access to that care? How many have lost their lives? That access to that care? We are beginning down that journey. Interestingly, following the request and vision of our county colleagues, we began to work with our jail health colleagues to provide these services. The very first service that was requested was podiatry and interestingly, the very first patient who came over from the jail to our east clinic had a threatened limb and not enough blood supply. And in risk of losing their foot. We immediately brought that person to the Wright vascular intervention service and saved that person's limb. So this is just one story to put into perspective what it means to create access without access has been missing for many years. So [11:06:56 AM] been missing for many years. So turning forward just a very brief overview of the 2025 budget highlights and priorities. Again, I apologize for the busy slide. There's a lot on this slide. We want to really make sure that we are accelerating in year two to continue to close those gaps, and the first point that I want to make here is a point of gratitude for the deep collaboration in our community. Many of the individuals on the dais and in the audience, but more we have come together in a way that really warms my heart and gives us hope to create a continuum of housing and health for our most vulnerable. Requires all sectors to work as one and provide housing and services together. And that is what we are leaning in to do. Amongst the highlights, we are taking the ground floor of the old children's hospital to clinical education center and building out approximately 40 beds of respite care that we [11:07:56 AM] beds of respite care that we will own and operate, and be able to place the adjacent services next to that people will need. In addition to the medical care and social care applying for disability housing, clinical care. And so on, we are also investing significantly in transitions of care services, millions of dollars to ensure that we can connect the dots between the hospital, the skilled nursing facility and the home. We are creating bridge teams, which you'll hear more about from my colleague in a moment that provide a connection between the street and our clinical services. Also, our austin-travis county ems services really filling in a key need there. We are providing map and disability application assistance. Most recently really scaling up services at sunrise church and more that we anticipate a six times increase in the volume of direct specialty care visits that will be provided by our central [11:08:58 AM] be provided by our central health clinical teams in the coming year. Over last year, we are increasing investment and collaboration in many ways with community care and sendero. We are making a major investment in integral care and mental health services, outpatient, psychiatric, emergency services. We believe in the work that our colleagues are doing, and we know that we are doing the same mission based work, often for the same individuals and populations, and our intent is to create a shared vision of what that physical and mental health care continuum looks like and work together to achieve that vision. We are making major bricks and mortar investments in eastern Travis county. We anticipate Delvalle health and wellness center to open the spring of this coming year. While construction at the Cameron center and colony park is ongoing, we are continuing to collaborate with Travis county to expand the inmate health services diversion and map enrollment, and we are partnering with many community based organizations, many community based organizations of color, to broaden our reach and address food insecurity, [11:09:58 AM] address food insecurity, housing, homelessness, mental health, trauma, and more. Visually, this is one way of seeing the investment and the volume of care across many different specialty lines, all of which were significantly gapped prior to our beginning. This direct investment between last year and the coming fiscal year, visually, these are the three locations that came online in the last fiscal year. Roads at Zaragoza east Austin specialty clinic and capital plaza, and then these are the four that are in process in the coming year. Cameron center in the north, the Hancock center in the center, the clinical education center, and then the colony park health and wellness center and the eastern crescent. And so I'm going to address just the opening slide here in this important segment about addressing housing for health through partnership. And then invite my colleague, chief strategy officer Monica Crowley, to, to go deeper into this topic, many of you have seen [11:11:00 AM] topic, many of you have seen this design slide, housing for health partnership slide underline on the partnership and underline on the goal to bring services or care and housing together. I had the privilege of attending a screening of the beyond the bridge film that perhaps you are aware of as well. And my colleague David gray was part of a panel that discussed this key lesson that across the country, as we reflect on what works, housing plus services, with all sectors collaborating to a common goal is what works. So on this slide, you see respite care on the left hand side, a place to heal. If you come out of the hospital, you need to heal a surgical wound. You need to have antibiotics for several weeks. You have to have a place to heal. But if you go back to the street after that, we haven't changed. Underlying condition. So our commitment to central health is to stay with you for that first year. We know the journey is more than a year, but at least that first year, if you come into our respite [11:12:01 AM] come into our respite environment, we will accompany you for that first year and try to ensure that you have the care that you need and the housing that you need while working with our many partners and navigating that road in the middle to stay alongside you and never let you go. Work with our ems colleagues. If you pop up in the 901 grid to get you back to our bridge clinic and so forth, I won't go into deeper detail here, because I know Monica Crowley will provide for the details in the slides to follow. So let me invite my colleague Monica Crowley up to take us forward here. Monica. >> Thank you. I'm Monica Crowley, central health's chief strategy officer. And thank you for letting us provide this information to you today. And I also am going to apologize for this very, very busy slide. Central health's upcoming demographic report continues to show that what we all know that experiencing homelessness makes it more likely that you will also be diagnosed with one or [11:13:02 AM] also be diagnosed with one or more chronic illnesses, and also in any number of chronic illnesses, medical and mental and behavioral. It also makes you 20 to 27% more likely that for any of those individual illnesses that you're more likely than anyone else in the population to be diagnosed with those illnesses, which is one of the reasons that central health is investing in closing this health care equity gap through investments in service expansions across almost every area of the health care continuum. And this slide is kind of a preview of collaborative work that we are doing with the assistant city manager. Hayden-howard, thank you for convening this. And David gray and echo and integral care and the county in really looking at all of the investments that each of our organizations or institutions is making in services for people [11:14:03 AM] making in services for people experiencing homelessness, so that we can align our work better, and also so that we can value the total investment that's being made across all of these different areas. We are presenting to our internal working group next Monday. On December ninth, and there will be in each of the drop down bullets, there's going to be a valuation and a list of different projects and programs that accompany each of those bullets in comprehensive, primary and specialty care, integrated outpatient and post-acute care investments, and service coordination and support, and also in early intervention, diversion, and behavioral health services and then direct investments that we're making in infrastructure and facility expansion. So this is kind of a preview slide. And we will have more detail to come that goes along with this. I [11:15:04 AM] that goes along with this. I know that doctor Lee mentioned the increase in respite care services. Here's a little bit more detail in this increase in respite care services. And this is a look at the number of bed days. Which bed days means the total number of available beds multiplied by the number of days each bed was used to provide care in a year. This slide represents our increase in services over this program. Started in 2023 for central health. It's contracting with community providers, which are and have been very limited. And so if you looked at our threshold that we started with, that was the 3200 bed days, which reflects that we were contracting at the beginning of fiscal year 2024 for about ten [11:16:05 AM] fiscal year 2024 for about ten beds across the community. We had the intention of expanding the beds that we were able to contract for, but we set our goal at 3600 bed days because we didn't know how many additional beds would be available. And, you know, we also would like to thank the city for making beds available in different locations in the marshaling yard than we hadn't known if that would happen. And so the reason that we were able to actually increase the bed days from this baseline of 3200 to almost, you know, 60, 67, over 6700, is that we went from contracting for ten beds to contracting for 25 beds over the course of the year. And so we were able to significantly increase the bed days. And next year, as we actually open our [11:17:06 AM] year, as we actually open our own facility with between standing it up, it will eventually have 40 additional beds on top of this next year. We're hoping to actually open up operate starting with 30 beds and then it will expand to 40 beds over the course of the year. One of the things that doctor Lee mentioned is that when you have the additional health care services and wraparound services, that's something that really improves the outcomes. However, in a respite setting, because of licensing requirements and regulations, you can't provide comprehensive medical services in a respite facility because then it would have to be licensed as a skilled nursing facility. And so this has necessitated the development of the bridge clinics that doctor Lee was talking about. And we [11:18:07 AM] Lee was talking about. And we started the bridge clinic last towards the end of the last fiscal year at capitol plaza. And the bridge clinic is a transitional clinic that allows central health to provide comprehensive, coordinated medical and behavioral health and counseling and psychiatry and specialty care services to patients that we started with, patients that were in our respite care facilities, and we would bring the patients from the respite care facilities to the bridge clinic so people could get this comprehensive, higher level of care. And one of the things that we've heard is it's not just getting that higher level of care. It's receiving care from the doctors and nurses that visit you when you're in the respite center. And so, you know, they have this trusted face of the person that they're working with and that [11:19:09 AM] they're working with and that they've worked with in respite and sometimes even doctors that have worked in mobile clinics on, you know, when people were unhoused or before they went into respite. And so they feel like they've got this medical home where people know their story, people know who they are. They have this kind of trusted relationship. The second phase of the bridge clinic, which recently started, was working with ems, where the ems providers bring lower acuity ems patients directly to the bridge clinic if they're patients that don't need to be treated at a hospital facility, they can bring them directly to the bridge clinic, where they can receive care and be triaged in real time and receive this higher level of specialty care, things like x-rays. Instead of having to be transported to the hospital. And it also creates this bridge to these patients to [11:20:12 AM] this bridge to these patients to be transitioned into a medical home at community care down the road, when they are more stable, and when they're able to transition into a primary care medical home. The next phase of the bridge clinic is going to be an actual mobile bridge clinic. And so far, we've hosted three kind of mobile outreach events in the community. One was at hungry hill, and then there were other ones at the arch, and we intend in January to expand these mobile services with a full mobile team that's going to be able to provide these comprehensive and coordinated services in community based settings on on site. So that will start in January. Having that kind of mobile transition and the physical bridge clinic [11:21:14 AM] and the physical bridge clinic also provides a way for providers and support personnel and staff who are working with this very vulnerable population. Sometimes when you're working directly with patients in a street based setting, that can be very stressful. It can be traumatic for the providers in many ways. And so being able to have a transition where you're working in that physical, clinical setting sometimes and then where you're also working in that mobile setting is something that also provides a better quality of life for the people who are directly providing the care, which also makes the care better for the patients. And it wouldn't be a central health presentation if we didn't have another patient story. And this patient story. These pictures are all patients who have been cared for in the [11:22:15 AM] who have been cared for in the bridge clinic by doctor Audrey Kwong, who you are all familiar with and who wanted to share their stories. And this story really is about our first bridge patient who was named Glenda. But who prefers to go by Gigi. She came to our respite care setting after three weeks in-patient at Dell seat, and then another two weeks in a skilled nursing facility stay when she was initially hospitalized, she was found unconscious and she was in shock with heart failure and with kidney failure. And she required short term dialysis. And she also required a number of heart medications in order to stabilize herself. And when she came into the respite setting, there was a high level of need to really coordinate care, including special blood thinners, because she had a blood clot in her neck, they [11:23:18 AM] blood clot in her neck, they needed additional ongoing kind of hands on cardiology care to treat her heart failure. She needed nephrologist that were available to treat her ongoing kidney failure. She was diagnosed with bipolar disorder and she needed psychiatric care. And then she had a long history of self- medication and needed access to the medication assisted therapy clinic in order to address her long history of substance use disorder and being able to come into the central health bridge clinic setting, she's able to get her labs done on site. She was able to see the specialist on site. She was able to meet with a nutritionist on site. She was able to get a well-woman check for the first time in over 20 years, and she shared with doctor Kwong that she felt so lucky to be alive that she really felt like she had a safe team that also was invested in her in trying to [11:24:19 AM] invested in her in trying to support her, both physically and emotionally, so that she could could remain healthy. And then since she was one of the first respite care patients to be seen in the bridge clinic as other patients started to come into the respite facility where she was that needed to go to bridge, she was kind of a coach that would serve as as a coach to bring in her peers into being comfortable, you know, making the most of the services that were available. And then finally, we just didn't want to not mention the permanent supportive health care, permanent supportive housing, health care, collaborative, that central health, it was convened by doctor Tim mercer and doctor Ashley trust at the university of Texas. And this was a community true community collaboration that developed a model for providing integrated [11:25:19 AM] model for providing integrated mental and behavioral health services through mobile teams in the new permanent supportive housing sites that are coming online over the coming year, and central health has continued working with echo in a role coordinating the care provision and the payment of community care and integral care, and managing fidelity to the dsh hcc model. That was developed by the community so that there is a standard model of how services are going to be provided to the newly housed populations in the housing that is coming online, so that people can both stay healthy and stay stably in the new housing. And our first housing site that the dsh hcc is going to be supporting are the [11:26:20 AM] going to be supporting are the two new integral care psh sites that have recently come online. Thank you. >> Thank you. Monica I can't help but take the opportunity to thank our colleagues at UT del med school. I believe we get tremendous value from the presence of the medical school from our leader, Dean Claudia cannetti there and the many touch points and collaboration from recruiting the health providers that our community needs to innovatively designing service lines, like you just heard with the healthcare collaborative. So I just want to say that and this final slide here, I'm actually channeling something that doctor snehal Patel shared with our board. Doctor Patel was a hospitalist at Dell Seton medical school, Dell Seton medical center. Excuse me. And he described how [11:27:21 AM] Excuse me. And he described how one of the most difficult and heartbreaking experiences he had was repeatedly being the physician who had to discharge unhoused individuals, sometimes after they'd had both their legs amputated back to the street. And a day arrived where he could no longer do it anymore. And he left that role, and he came to work for us at central health to join doctor jamali Patel and doctor Alan qalisha and others in leading our transition care efforts. And he shared with our board that he is delighted to report that that event very rarely happens now. It's very rarely the case that somebody is discharged with both their legs amputated back to the street, because we will accept that person into our respite environment, or we will accept them into our skilled nursing facility environment and follow them with doctor Patel's team. We will ensure that while we are always improving, there is a [11:28:22 AM] always improving, there is a much more dignified and human destination for that person and that is what gives doctor Patel hope. It's what gives me hope. We have a lot of work still to do, but the privilege of closing some of these very painful, unjust and inhumane and lethal gaps in our care system, that is what we are here to do. And we appreciate the opportunity to be with you today and to have been with you in Denver. As you know, under the leadership of David gray and many others, I think a rather historic 30 person delegation went to learn from our colleagues to kind of humbly absorb those lessons. And then we're going to be meeting shortly to digest this. So I won't go deeper, but just to say thank you, it is a privilege to be in this community with all of you and we are grateful for the opportunity to work alongside in service to our public health. >> Thank you, thank you, thank you, doctor Lee. Colleagues. [11:29:23 AM] you, doctor Lee. Colleagues. Questions. Vice chair Velazquez to kick us off. >> Yeah. Thank you so much. And thank you for that wonderful photo. I was curious on slide 13, you have for outpatient care who are our partners with with this undertaking, our outpatient care partners. >> And do you mean specifically in primary care or across all of the care in primary care? Yes. So by far and away, our largest primary care partner is community care. Around 140,000 unique individuals receive care primary care at community care in this past fiscal year, and we broadened out to a three year run rate. The approximate number is around 250,000. And so this is a significant number of people who trust community care and receive, I believe, outstanding care. At community care, we also work very closely with the people's clinic community clinic and with lone star circle of care. So those [11:30:24 AM] star circle of care. So those three fqhcs are our primary partners in primary care. >> Thank you. On slide 24, under sdoh, we have 1 million for in community health initiatives fund expanding programs focused on food insecurity. What types of programs are we talking about with that 1 million? >> Yeah. Monica, I wonder if you'd be willing to speak a little bit to the community health improvement fund. I'll just be right here. Yes. >> So the community health initiative fund, that is going to be we're going to put out a request for proposals within the next. I think it went to our procurement office a couple of days ago, and we are really looking for proposals around medical, medically tailored meals around probably about six chronic conditions that are prevalent in central health populations and for providing food, pharmacy type services. [11:31:26 AM] food, pharmacy type services. You know, where you provide a kind of healthy fruits and vegetables and shelf stable, you know, food supplies at our Hornsby bend clinic at the southeast health and wellness center, at Rosenberg clinic and once the Delvalle clinic is opened and then we're also looking for proposals around the preparation of food by and for people experiencing homelessness. That also meets a certain kind of list of dietitian set requirements. >> And thank you. And you mentioned six most prevalent categories. What are those six? >> I can't tell you off the top of my head, I know they include diabetes and heart failure and chronic kidney disease. And I'm not sure what the other three are, but we can get that [11:32:27 AM] are, but we can get that information and share it with you. >> Thank you so much, chair, that those are all my questions. >> Councilmember Ryan alter, I was wondering and I should know the answer to this, but I don't map versus map basic. >> Yes, sir. Can you just talk about the difference in who's getting what what the services are? >> Absolutely. And I will acknowledge I'm not our organization's foremost expert in this, but I'll take a crack at it. So the map is the medical access program. This is a set of foundational program. The main component of which is for individuals up to 100% of the federal poverty level. They have to be residents of Travis county or have the intent to spend the night in Travis county, should they be unhoused. It provides a fairly comprehensive set of services. It's an indigent care program, and many of our local partners, from hospitals to diagnostic services, outpatient [11:33:29 AM] diagnostic services, outpatient care services, specialist services, except map and we negotiate rates similar to an insurance product, although we are not insurance, that is not an insurance plan. So that's the map component. And it is the changing of the core criteria for who can get map requires agreement between us and ascension, which is why we haven't been able to move the recurring six month eligibility window. So every six months, individual rolls off map and has to reapply. Oftentimes they don't know that and they end up with gaps in coverage. It's very frustrating for our community and frustrating for us. Map basic then attempts to build upon the core map component. It goes up to 200% of the federal poverty limit, and there are other components that may focus on dental care, I believe, and other sort of subdivisions of it, but it is in some cases a [11:34:30 AM] it, but it is in some cases a slightly less robust set of services but still meaningful access. And similar to map, we negotiate those rates with various providers throughout the community. So this is the indigent care program, collectively up to 200% of the fpl and is that fully funded through central health or do you get federal funding or state funding or this is fully funded through central health, through a public tax dollars. >> Got it. Okay. So it would safe to assume that most, if not all unhoused individuals would qualify either for map or map basic. It's then just whether they can maintain that eligibility. That is the problem we run into. >> That's right. And I would add that sendero health runs a very interesting, innovative program called the chap expansion program. And I believe chat stands for central health assistance program. But what this is, is an off marketplace [11:35:31 AM] this is, is an off marketplace platinum plan in which central health pays the full premium dollar in the current state, there are just south of 800 individuals in this plan. They have the highest acuity needs throughout our community, and the total premium costs are approximately $10 million. So central health pays for that full amount. Each individual doesn't pay anything but the total cost of care in that plan for those 800 individuals runs to about $50 million. And those individuals have received liver transplants, kidney transplants, bone marrow transplants, car-t therapy. That's that newest cutting edge therapy where the team removes your immune cells, programs them to attack your cancer, puts them back inside you and your own souped up immune system eliminates your cancer. This is sort of the cutting edge standard of care that's available in our community, and not many people are aware that our patients are [11:36:33 AM] are aware that our patients are actually getting access to this. And the other $40 million comes to the risk adjustment transfer through sharing with the national ACA pool. It requires some careful balancing of risk within senderos portfolio, so we're always watching that carefully. But it's a highly innovative way to provide the highest level of care. And with that platinum exchange plan, these patients can get access to care anywhere in our community. That plan is accepted by by everybody. >> And were those individuals I think you said this, but you're when we were in Denver, you know, they talked about the frequent fliers and trying to cordon off and deal with the small portion of people who are overly utilizing services. And if we could, you know, address those individuals, then it provides a lot of relief on the entire system. Is that kind of similar corollary here? Like you're seeking out those who are the highest frequency users or the greatest utilizers. [11:37:36 AM] the greatest utilizers. >> Yes. I think this is a this is a key way to address and leverage the total cost of care and bring in other resources. But I would say that that sort of top 1 to 5% that drives between 50 and 80% of health care costs nationally, and I don't know the exact number in our community, but it's probably, you know, a not far off. We are serving them through a range of services that include a lot of what you've heard about today, the transitions of care services, the bridge services, the mobile services, the integrated behavioral health and substance use services. So there's a broad range of needs. Not everyone can qualify for the chop expansion program. And so that is very much our focus to care for those who are falling through the cracks, but costing the public a tremendous amount along the way. I didn't mention it today, but we know through the work of the episcopal health foundation, saint David's foundation, and others in the report, the economic impact of health disparities in Texas, [11:38:37 AM] health disparities in Texas, that the annual cost to our county alone of health disparities is at least $1.1 billion every year, and the methods only estimate the cost of the individual. And we know that the costs are broader than the individual. They affect the family. They affect the community, they affect public safety and so on. And so we are paying an enormous economic cost by not addressing these health disparities in our community. We know that we would never pass that bill or budget to do that proactively. But but that's what's happening in the current state. And so we're doing our best to interrupt the root causes of that problem and not only save lives, but also prevent waste of that economic vitality in our community. >> The last question is around mental health treatment and substance use treatment. Of course, tying that to homelessness, you know, it's something we see a lot of individuals need. And then we start talking central health [11:39:39 AM] start talking central health versus integral care. And I'm just curious how you see both your role in collaboration with integral care versus their role, as well as having the resources and just scope of services necessary to help, you know, what I imagine are thousands of unhoused individuals and people who are housed and need mental health services in our community. >> It's such an important question. There's sort of a the battle cry, if you will, globally that there is no health without mental health. I think that is true. And we know that the number of folks who experience some sort of significant mental health issue may be half or more of our overall population that we serve. And in the unhoused population, serious mental [11:40:39 AM] population, serious mental illness or serious substance use concerns are extremely high based on our map map, basic data and in the population of folks who come into our respite services, it's 2 to 3 times higher than that background map map basic burden of disease around mental health and all all serious illness. Actually, these are these are the most vulnerable, most acutely affected. So all of which to say number one, that there is so much burden and need that no one agency can do it all. The second point I'll make is that we believe that the work in in creating whole person care is not a matter of aligning all the verticals, thinking about the verticals of care, but rather thinking horizontally. What are the patient journeys through this complex space? How do we follow a one size fits one across these? Across these verticals, and allow us to organize our thinking and our [11:41:40 AM] organize our thinking and our work around a patient? If you think about it from a patient or a group of patients or a community perspective, any given day there are people in our community who need care. Many times they're aware of the need. Sometimes they may not know their blood pressure is as high as it is, or that the alcohol intake has moved to a stage where they really need help, but they still need the care. And it is the delay in the recognition of that need or the meeting of that need in a way that's high quality, that is dignified, that is culturally competent, that is convenient and timely. Meeting the need that people have for care, that delay causes most and perhaps almost all, of the health inequities we see. If we could eliminate that delay, we would vastly close the gap in health equity in our community. So with that, as a background, I also want to take the opportunity to just thank and praise my colleague Jeff Richardson. It's a blessing to have him in our community and his whole team. To answer your question directly, we spent time [11:42:42 AM] question directly, we spent time building relationships and trust sharing, you know, a meal together with their teams, going to see each other's places of work together, coming to understand both the highs and the lows, the opportunities and the challenges we both see and really committing to developing together a shared vision of what that care continuum looks like from a patient perspective. If you imagine any individual who has both physical and mental illness, they have a lower to higher acuity of physical illness and lower the higher acuity of mental health. And they may move over time. Between these quadrants. And furthermore, they may have a place or a provider who they trust. They may want to see their primary care provider or they may want to go see their behavioral health provider, even if their needs on the other dimension are higher, if you will. And our goal is to braid and blend the care provision so that we can follow people to where they're trusted site of service and access is and provide the care they need. So we want to come to a shared [11:43:43 AM] we want to come to a shared vision of what true north looks like across our care continuum, and then together optimize to that goal rather than suboptimize to do different agencies. And so we're already doing that work on a regular ongoing basis. And I think making some good progress. You do raise the challenge of funding. That's a reality that we face. We know we have the privilege of the special purpose taxing revenue, but that is not a bottomless well. And there's more need than there is capacity or resources. So to your point, council member alter, there are ways that we can improve the flow through our system. If a hospital stay on average is 7 to 8 days, but it really only needs to be four days and we get it down to four days. We can take care of two times as many people in that hospital bed. And so how do we remove the sources of friction, the bottlenecks, the delays that exist throughout our system at every care transition [11:44:44 AM] system at every care transition point in these acute care settings, there's the time you need to be there to get the care you need, and there's all the time that you're just waiting to go someplace safe and there's no access, or there's a bottleneck. And so Jeff and I share that view. And he has that experience coming from Sheppard Pratt. And we we're excited to continue to improve and try to create that sort of rational and smoothly flowing and ultimately patient centered care system. >> Thank you. Thank you very much. >> Thank you. Thank you, doctor Lee. I'm colleagues. I'm going to hold my questions because we do have another briefing to get to. And we have about 15 minutes left in our meeting. So I'll, I'll, I'll coordinate with our central health team for a follow up meeting so that we can have a further conversation. But thank you all for joining us today. We really appreciate the update. >> Thanks so much, colleagues. It's truly an honor. >> Thank you. >> All right. Next up is receiving an update on the city's marshaling yard, which provides temporary shelter to individuals experiencing homelessness by our homelessness [11:45:44 AM] homelessness by our homelessness strategy office. Welcome. David gray. >> Thank you, madam chair and council members. And before I begin, I just also want to give my love and praise to doctor Lee and the team at central health. They've been phenomenal partners since I've been in this role and since doctor Lee started at central health not too long after I started in this role, and so just really grateful for the partnership and for the work. Today, I want to give you an update on our operations at the marshaling yard. Emergency shelter, and talk about some of the next steps that we're envisioning with this temporary facility. As many of you know, the marshaling yard emergency shelter opened in August of last year with the capacity to serve up to 300 clients when clients are entrusted into our care at the marshaling yard shelter, they receive a number of benefits, ranging from door to door transportation services to a to a safe place to shelter their pet workforce and job training services to laundry services, meals and everything in between. We try to provide as many needs as possible for all [11:46:45 AM] many needs as possible for all the clients who we serve out of this facility. I want to talk a little bit about marshaling yard by the numbers. And these are numbers between when we opened in August all the way to October 31st of this year. We've served over 1000 clients out of the marshaling yard, helping nearly 200 successfully exit to a permanent housing destination, which could be permanent, supportive housing. Some of it is family reunification, some of it is helping clients transition into private rentals and so we're really excited for the 184 people who we've helped exit successfully. We've also served nearly 200,000 meals to our clients, completed 450 coordinated assessments, which, as you know, the coordinated assessment is essentially the entryway into a permanent, supportive housing placement. Within our community, we've sheltered 40 animals, mostly dogs, one cat still haven't gotten that snake yet, but I know the snake is on the way. We've helped 68 people secure their vital records, including [11:47:45 AM] their vital records, including birth certificates, and we provided 29 clients with clothing assistance. I do want to tip my hat to our vendor endeavors. Their staff worked tirelessly around the clock, seven days a week to make sure that clients have all their needs met. And so this is just a quick snapshot of some of the many services that we've been able to deliver to our clients out of this space. Now, I know you're also really concerned about successful exit rates from the marshaling yard. And so with this slide looks at is the exit rates by quarter since we opened. And what I mean by exit rate by quarter is we look at all the clients who have exited each quarter and calculate which percentage of those clients exited positively versus exited, either negatively or to an unknown destination. And you'll see that when we open the marshaling yard in that first quarter, quarter two of fiscal year 2023, our positive exit rate was less than 15%, which means 15% of everybody who left left to a confirmed housing [11:48:48 AM] left to a confirmed housing destination. The remainder left either negatively or we have no idea where they ended up. As of last quarter, we've increased our positive exit rate to nearly 30%, meaning that almost one in every three people who are exiting marshaling yard are exiting to a permanent housing destination. I think what this demonstrates is that we are doing a better job at getting people housed. We're doing a better job at providing quality services and keeping people stably in the marshaling yard until we're able to get them rehoused. And we've been able to double our positive success rate since we've opened. I think what this also demonstrates is, frankly, we still have some more work to do. Our goal is to get this rate up to 100%. And so we're going to continue to work with endeavors and with our community as we strive towards perfection in terms of kind of where we're going from here. So back in September, city council adopted this resolution that directed city staff to do three key things. The first was to identify funding to keep the [11:49:50 AM] identify funding to keep the marshaling yard open without taking money from other homeless services. The second was to set a target rate for positive exits, and the third was to provide the quarterly updates to the public health committee. I'm pleased to stand here before you today to announce that we've identified a pathway for funding that allows us to keep the marshaling yard open through the end of this fiscal year. Now, future operations will be contingent upon council's budget decisions. When we come up for budget discussions for fy 2026 and beyond. But at least with the budget that you've approved this fiscal year, we've identified funding to keep the marshaling yard open. As I showed on the last slide, we've also improved our positive exit rates since we were anticipating closing the marshaling yard. We had not yet done the work of setting target positive exit rates, but assuming that council approves an item that we're bringing for your consideration next week, we are going to work to set those target positive exit rates in the coming months, and we'll be sure to present that information to you all, as well as others on the council [11:50:50 AM] well as others on the council dais. The third is we're delivering the update today. And of course, we're committed to coming quarterly with updates on the marshaling yard. I also want to talk about intake at all city owned shelters. As you're all aware, we paused intake across shelters because we anticipated needing to move our marshaling yard clients to other shelters in the system. Now that we've identified a pathway to keep the marshaling yard open, we have initiated intake at the shelters. Again, we're excited for the opportunity to bring people off the streets and get them indoors, especially now as we're heading into the cold weather season as well as the rainy weather season for marshaling yard intake at marshaling yard will continue to be reserved for city departments and city owned. I'm sorry, city initiated efforts. And so these are things like addressing encampments that are in high wildfire risk areas or on days like today, addressing encampments that are in creeks and waterways that we believe are at risk of flooding. It also is for individuals who might get stopped by one of our law enforcement partners at the [11:51:51 AM] enforcement partners at the Austin police department and are requesting a safe place to stay. We want to make sure that we have access points for those folks. 24 over seven in the marshaling yard will be used for that purpose. Northbridge and southbridge will continue to be our primary shelters for heal, which is the housing focused encampment assistance link initiative. We are also going to coordinate intake at these shelters with other street outreach organizations. Oftentimes, we come in contact with one of our street outreach partners who tells us that they have a client in an encampment. That client has received the housing voucher they're waiting for their unit to be ready. The unit is going to be ready in a week or two, and they just need a safe place for that client to be indoors during that gap. And so we're going to use northbridge and southbridge as a way to accommodate those gap needs. As an elexampen, wh it comes to Austin resource center for the for the homeless or the arch and our eighth street shelters, one thing that we heard really loudly from our community in the past was that there was no way for community members on their own to call and to get added to a wait list so [11:52:51 AM] to get added to a wait list so that they can get into shelters themselves. Some people felt like having to go through the city, or having to go through a service provider was a little bit too restrictive. And so for arch and for H street, we're going to try something new. And this is in direct response to the community feedback that we've received. Community members for can self-refer into arch and H street. But I want to be clear that these are not walk up shelters. It's not walk up beds through a contract that we recently entered into with sunrise, where we've expanded their phone hotline, which is their their primary way now of providing community services. Individuals can contact that sunrise navigation center hotline. They can request to be added to the waitlist for the arch and for the H street sunrise will take the client's information. They'll put them on the waitlist and the homeless strategy office in partnership with urban alchemy, will manage that waitlist and we'll pull people off of the waitlist for the beds that are available at the arch and that are the H street shelter. Now, to keep the got the end meeting, notice I got you. Okay. You don't have to [11:53:53 AM] got you. Okay. You don't have to be passive aggressive like that, my man. Geez. No, I'm just I'm just playing. I know I was like, I think I'm talking fast. I blame central health. Doctor Lee was very long winded. Sorry, doctor Lee. All right, so community members can contact the hotline to try to keep the waitlist manageable. We're going to do is close the waitlist. Once it reaches 200 clients. Kind of once you have these waitlists that become 800, 900 clients long, they don't really serve a practical purpose at that point. So we're going to close the waitlist when it reaches 200. We're going to work the list at that point, and we're going to reopen the waitlist when we get it down to 50 clients. And we'll be sure to leverage all of our communications tools from social media to ctas, to make sure that individuals know when the waitlist for arch and H street are open and when the waitlist for arch and H street are closed. And we'll have a press release going out later today to the effect that will inform the community members of these changes. So just in terms of next steps, three key things I had mentioned. Next week we are going to come to council seeking [11:54:54 AM] going to come to council seeking the authorization to amend our contract with endeavors. That authorization will allow us to keep the marshaling yard open. And so that item is publicly posted on the December 12th agenda. We're also in the process of working with the Austin convention center to reconfigure the shelter layout to accommodate the needs of the Austin convention center. Prior to demolish the downtown convention center. What this means is we're going to reduce our footprint at marshaling yard, but we'll still be able to provide the same quality services that we're providing. This just avoids us having to lease a new facility for the convention center, or lease a new facility for the homeless strategy office. I also want to be very clear that we're going to continue searching for a permanent shelter, although we're very grateful for the opportunity to keep this shelter open. This is intended to be a temporary shelter. Our main priority is still to find a permanent replacement for the marshaling yard. And last, I want to end just with a personal thanks to our friends over at zetas, which is a local Tex-Mex [11:55:56 AM] zetas, which is a local Tex-Mex Tex-Mex restaurant. They they donated more than 700 meals last week so that we can offer Thanksgiving meals to our clients at the arch, the H street out of the oasis, and at the marshaling yard. And in this photo, you'll see our beloved city manager, tc Broadnax, him and his wife and assistant city manager Hayden Howard joined me at the marshaling yard on Thanksgiving eve to hand out 300 meals to our clients and just to hang out with our clients down there and show them that we love them, we care for them, and we are thankful for them and for the trust that they placed in us. Each and every day. So with that council, I know I ran through that pretty quickly. But madam chair, I'm happy to answer any questions should you have any. And again, thank you for the opportunity for us to be able to do this work. >> A quick question on my part and thank you for the update. So it sounds like for us to extend the operations of the marshaling yard, it's about a million dollars a month. Can you share where that funding will be? What pathway you identified for that [11:56:57 AM] pathway you identified for that funding? >> Sure. >> So it's a combination of underutilized arpa funds from other categories not related to homelessness that we're going to be able to place into this contract. And then there's also some general fund dollars. But to get the specifics, I would have to have Kerri Lang from the budget office or one of our colleagues from financial services be able to address that further. >> Yeah, I think prior to council consideration, if I can get some more detail on where that funding is coming from, and I appreciate your efforts in identifying a permanent location. You know, obviously, $1 million a month going towards the marshaling yard is not a sustainable amount for us. Certainly want to continue investments in emergency shelter, but we'd be looking for us to help prioritize that relocation. >> Yes, ma'am. >> Council member Velasquez, thank you for the presentation. >> I echo the sentiments of my of my colleague here and the chair. Should we hit September 2025? And we need to we need to vacate or we look to vacate because there's no we can't [11:57:58 AM] because there's no we can't continue at the marshaling yard or we choose to not to continue at the Marshall marshaling yard. How much time would we need to start ramping down? >> So we usually need about four months to start ramping down, 3 to 4 months to start ramping down. Another thing that we're exploring that I didn't put in today's presentation is adding beds at some of the other shelters that we currently have. And so should we find a pathway that allows us to do that. It might shorten our ramp down window at marshaling yard, because we would have more capacity elsewhere in the system to accommodate those clients, but at present, it's about a 3 to 4 month window to do a complete wind down. >> Thank you. And I'm not sure if you were if you were trying to put me on blast because I couldn't make it out to volunteer that day on Thanksgiving eve. But I would like to say, if there are ever any opportunities we have a service team that we that we grew out of the office, out of our office. I can't speak for everybody, but I know that I'd be more than happy to volunteer any chance that we get, if there, should the opportunity [11:58:59 AM] there, should the opportunity present themselves, especially at the marshaling yard, because it is in district three? Yes, sir. >> And you did offer to come, and I appreciate that. And we all know shift happens. But I, at least appreciate your willingness to come out. Yeah. >> No, we're excited to man Ryan had me caught up at at at the feast of sharing or feast of giving. And so we had a couple other things that week. But more than happy, any time that you have volunteer opportunities like I said, we have a service team out of the office. We'd love to bring some out. Yes, sir. >> Thank you. >> All right. Thank you. Thank you all right, colleagues, at our next council meeting, which will be in February, we'll receive an update on students and youth homelessness from lifeworks. Any other feedback on additional topics for us to consider? >> Yes. >> I think one good topic and whether it's at February or a different meeting, is for us to review the goals within the strategic plan that fall within public health. There are some related to homelessness. There's some related to just health in the community, but ahead of the budget, you know, these goals [12:00:00 PM] budget, you know, these goals will inform how those dollars are prioritized. And so I think it'd be really valuable for us to take a look at what those goals are and see if there's anything missing or if we want to make any tweaks or adjustments. >> Thank you. Also, I think getting an update on our bridge to psh policy will also be timely for us in the new year. And I think hearing from integral care and receiving an update on what they've been working on and doing, it sounds like they're doing some really incredible work. Any other feedback? All right. Thank you everyone for your participation and contributions today. We had a lot of important conversation. If there's no further business, I will adjourn this meeting at 12:00 on the dot. Thank you.