Assembly Select Committee on Select Committee on Orange County Homelessness and Mental Health Services

Good morning, everybody. We're going to go ahead and start trying to keep on time because it's because it's a Select hearing. Before we begin, I'm Assemblymember Sharon Quirk-Silva. I have a little bit of a cold, but just I'm fine. Just before we start the formal part, I will be doing welcome remarks and an introduction.

But those of you know me, usually I don't follow the script, but because it is a formal select hearing, I will be doing that and we will be following very carefully the agenda. We want to welcome you here today. So good morning and thank you for being here. I'm Assembly Member Sharon Quirk-Silva and I'm honored to serve the 67th California Assembly District which encompasses diverse communities of North Orange County and parts of Los Angeles.

As chair of the Assembly Select Committee on Orange County Homelessness and Mental Health Services, welcome to our first hearing of the 2023/2024 legislative session. I created the Select Committee with my colleagues to identify opportunities to strengthen ongoing working relationships between advocates, nonprofits, the private sector, as well as local and state government to address Orange County's homelessness crisis, as well as addressing mental health services and needs.

Our goal is to focus on the progress that the region has made, what we need to continue to work on, and the role of each of us that play a role in this part of alleviating homelessness. I understand that there are many roadblocks to providing housing for the county's growing population of chronically unhoused people, as well as services for those with mental health issues. There is no simple answer to address such complex problems.

However, it does take dedication and collaboration to support those who lack safe, stable, and appropriate places to live in Orange County, as well as access to various levels of mental health services. Additionally, we have to better understand and address contributing factors of homelessness and mental health issues and substance abuse. Thank you for being here today, for your work and dedication to provide services, address the needs of our communities, and share your knowledge and expertise with us today.

I believe it takes a village to support and improve the lives of our most vulnerable Californians. And I want to thank all of the panelists, advocates, and organizations for being part of our village. I'd like to recognize Members of the Assembly Select Committee on Orange County Homelessness and Mental Health Services. We will be having some Members come in and out and join us. But for now, we have Assemblymember Diane Dixon. We have Assemblymember Tri Ta. And I see Assemblymember Laurie Davis coming.

Others will be joining us. And on our program, we do have one of our panelists that will not be able to make it. That would be former Council Member Michelle Martinez. She is not able to make it. Just so you have that. And before we welcome our first panelists, I'd like to open it up to our Assembly Members. If you have any opening comments, you can move that all the way over.

Good morning, everyone. My name is Laurie Davies. I'm the state Assembly Member for District 74. That district is South Orange County, starting with Laguna Nigel, Dana Point, San Juan Capistrano, San Clemente, into Camp Pendleton, Vista, Oceanside and a little bit of Fallbrook. I want to say thank you so much for having this. Obviously, this is one of the top three concerns when you kind of do a survey through the state.

And I know that we are putting money in the budget to do what we need to do, but I think we can all agree it's just one solution doesn't fit all. We've got a lot of different solutions that we need to do, but one thing that I found is we have to make sure that there's connectivity with all of these groups. We have money that we give to a lot of good groups, nonprofits, cities, counties, but there isn't a lot of communication going on.

And I think that's what I hear when I talk to these agencies saying, we go here and we get to do this. But then when we try to move them from this next part, nothing's there. So we need to really make sure that we've got one circle, and it goes like this, and it connects. So thank you.

Good morning. I'm Diane Dixon, Assemblywoman from Assembly District 72, which includes Seal Beach, Huntington Beach, Newport Beach, Laguna Beach, Laguna Woods, Elisa Viejo, Laguna Hills and Lake Forest. Delighted to be here and thank you, Assemblywoman Quirk-Silva, for pulling this together. It is a difficult subject matter and I think this is going to be the first of several meetings because we can't solve it all in one day.

I know that learning for me especially, I'm interested in learning more about how Orange County collaborates, just as Assemblywoman Davies said, with different providers and members of the community to ensure that we're all working together in a common goal. One area in particular that will be a subject perhaps, I'm hopeful for a future meeting is that there is a convergence of social rehabilitation homes and sober living homes within the affordable housing discussion. And it affects many of our cities in all of our districts.

I want to be sure that we are really focused eventually on how all this is going to come together under the umbrella of affordable housing and how that affects our communities and our neighborhoods. And also, I just want to mention that the State Auditor's office is currently working on my request to conduct a holistic review of facilities licensed under the Department of Healthcare Services to help determine how certain facilities are licensed, certified and enforced. And we'll be getting those results in the spring period.

And the over concentration in residential neighborhoods of facilities and the effectiveness of patient care in these facilities is a concern for a lot of our coastal and other cities. And that is really the key point is getting people the care into integrating the mental illness, the social rehabilitation, and making sure people are being rehabilitated and getting the care that they need.

And this all ties together with homelessness because if people suffering from mental illness, suffering from various addictions, and they are no longer in these homes for whatever reason that they are in and then they're out, they're not rehabilitated, that directly impacts and data shows us the homeless situation crisis in our area. So I look forward to seeing how all this comes together and fits into the larger conversation. And thank you again, Assemblywoman, for pulling us all together. Thank you.

Thank you.

This is the issue that been going and I want to thanks Member from the community, elected official, for being here to raise your concerns. And I believe that every community in my district and in our county and entire State of California has been impact by this crisis. And for the past several years, as you're aware that California has spent up to 20 billion on homeless spending. However, we still hear, we still discuss about the issue.

It means in the past that even state California spent a lot of money on that, but we don't have an effective solution. So I think that we need to hear input from community, we need to hear from local elected official. And I look forward to the release of the State Auditor report on homeless spending. I think that's really important because I think that we all need to see that how much a state actually spend different angle of issue of homelessness.

And it's my expectation that a report that will at least address an approach that we have to spending and hope that we can have an answer why California spend so much. But we still here and we still have to deal with the. So I want to thank my colleagues, I want to thank members from the community and I'm here to keep my mind open, because at the end of the day, this is an issue that we all need to work together.

I believe that as long as we work together and we understand the issue and we're willing to deal with that, but at the end it needs to come from the local community. So, thank you so much.

Thank you. We're going to go ahead and begin. With our first panelist and we're going to welcome to our table over here Paula Wilhelm, the Assistant Deputy Director on Behavioral Health, Department of Healthcare. And we welcome you and look forward to your comments. Welcome.

Good morning, honorable Chair and Members. Again, Paula Wilhelm. I'm an Assistant Deputy Director for Behavioral Health at the Department of Healthcare Services, or DHCS. And on behalf of DHCS and the Administration, we really appreciate the opportunity to be here this morning and participate in the hearing and also hear from the members of the community that are testifying later on. I'd like to share a brief overview of a few key initiatives designed to prevent and reduce homelessness for people with behavioral health conditions.

And then we'll look forward to responding to the Committee's questions. So first I'll start by emphasizing how deeply committed DHCS and the Administration are to using all the tools at our disposal to address social drivers of health. Housing is at the top of the list of health related social needs that we want to impact through new MediCal initiatives and other targeted investments.

Housing is healthcare and we know we can't improve the health, mental health or well being of our population without investing in strategies to prevent and reduce homelessness. Consequently, the state is pursuing multiple opportunities to expand MediCal coverage for housing services, while also making direct investments in housing and behavioral health treatment options for people with significant behavioral health needs. So I want to start by talking about housing supports that are now available as part of the California Advancing and Innovating in MediCal Initiative, or CalAIM.

And as members of the audience may know, CalAIM is a long term commitment to transform and strengthen MediCal to improve the health of our members and reduce health disparities. The MediCal system as a whole is a key component of California's broader commitment to building a healthier and more equitable state.

We know that American Indian, Black and Latino Californians have long faced health disparities that are the result of long standing structural racism in the healthcare system, in employment opportunities, and in access to safe and stable housing. The pandemic exacerbated the homelessness crisis and these inequities and underscored the need for investments like we're making through CalAIM in whole person care strategies to address social drivers of health and housing.

So, two of the key housing focused components of CalAIM that are now available through MediCal managed care plans are Enhanced Care Management or ECM and Community Supports. ECM is a comprehensive care management benefit and people experiencing homelessness are now eligible for ECM in every county. Adults with significant behavioral health needs and children who meet criteria to access MediCal specialty mental health or substance use disorder services are also eligible for ECM.

ECM was really designed to address both clinical and non clinical needs, particularly health related social needs, through high touch coordination of services. So we think about the ECM care coordinator as the air traffic controller who can ensure that different providers and services work together to meet each person's needs. ECM care managers can now connect MediCal members to new housing services that our MediCal managed care plans can choose to cover as community supports.

So, some of the new housing services available as community supports in MediCal include housing transition and navigation services, housing deposits, housing tenancy supports, and short term post hospitalization housing, recuperative care, or day-habilitation. And these can all serve as alternatives to hospitalization or homelessness during care transitions. We are looking at data on utilization of these new services and we know that about 36,000 medical members who were experiencing homelessness received ECM in 2022. That was the count just for 2022.

So we've continued to expand access through 2023 and we'll have reporting up on that on our website that folks can access. We do know that it takes time, energy and multi agency collaboration to build out provider networks and connect to all of these services for people experiencing homelessness. So we've also leveraged our MediCal waivers to help finance capacity expansion in this area.

And we have programs like the Providing Access and Transforming Health or PATH initiative and the Incentive Payment Program which provide supplemental funding for our on the ground partners, including managed care plans, community based organizations, hospitals and counties to expand ECM and community supports. Next up, to build on our CalAIM foundation, DHCS will seek CMS approval to add transitional rent as a new MediCal community support service.

And if this is approved, managed care plans will be able to choose to cover up to six months of rent for eligible high need MediCal members. We also propose to make this transitional rent coverage available through our county specialty behavioral health plans. And this is just one of several services and supports included in a new mental health demonstration program. I'm excited to announce that DHCS just submitted last Friday our new 1115 waiver demonstration application to CMS.

And this is for the behavioral health community based networks of equitable care and treatment demonstration. A real mouthful, so we call it BH Connect. BH Connect is a new package of initiatives following CalAIM designed to strengthen and expand the statewide continuum of community based behavioral health services while taking advantage of an opportunity to receive limited federal funding for care provided during short term stays in institutions for mental disease or IMDs.

So, in addition to the transitional rent option under BH Connect, county behavioral health plans will be able to choose to expand coverage for several evidence based therapies that improve behavioral health outcomes and reduce the risk of homelessness. New MediCal services available under BH Connect will include assertive community treatment or act supported employment and clubhouse model services. To ensure county behavioral health plans are able to implement these new services successfully.

DHCS will also develop an incentive program to support counties that demonstrate success at improving outcomes among our most vulnerable MediCal Members. So people experiencing homelessness are a population of focus for BH Connect as well as CalAIM. I think I would also be remiss if I didn't acknowledge another new initiative that launched this month here in Orange County, and that is the Care Act.

As many of you know, care is an upstream diversion that uses a new civil court process to prevent more restrictive conservatorships or incarceration for people with schizophrenia, spectrum disorders or other psychotic disorders. So care is based on evidence that people can stabilize, begin healing, and exit homelessness when they receive care in less restrictive, community based settings.

And what care is supposed to do is improve housing stability, medication adherence, and overall functioning for individuals experiencing homelessness via wraparound services provided under a court ordered care agreement or care plan. And the care plans may include an array of health and social services and housing interventions.

And so at this point, as I'm coming toward the end of my remarks, I want to acknowledge that to meet the needs of our MediCal Members, care participants, Californians experiencing homelessness and behavioral health conditions, we need to continue to develop our array of high quality treatment settings and housing options. So the MediCal coverage that I've been talking about needs to be paired with access to actual brick and mortar housing and clinically appropriate behavioral health treatment options.

So I'm going to briefly highlight a few programs from the California Department of Social Services who are not represented today, but we wanted to mention their work as well. And then close by touching on a couple of the programs administered by DHCS, which expand the array of housing options available specifically to individuals with behavioral health conditions.

So, on behalf of the Department of Social Services, CDSS administers multiple programs that integrate tailored housing services within safety net systems grantees of CDSS's housing programs are expected to coordinate with other local government agencies, continuums of Care and Public housing authorities to holistically meet the needs of each individual client. So a few of the programs that CDSs administers that everyone may be familiar with, we have Housing supports available through CalWORKS, the CalWORKS Housing Support Program and Housing Assistance Program.

We have Bringing Families Home, which is specifically for families involved in Child Welfare Services. We have Home Safe, which serves individuals engaged with Adult Protective Services. And we have the Housing and Disability Advocacy Program, which targets individuals who are eligible for disability benefits, including Supplemental Security Income or SSI, specifically for individuals with behavioral health needs. CDSS also administers the community care expansion program. This launched in fiscal year 2122 to address historic gaps in behavioral health and long term care.

So to date, CDSs has awarded 353,000,000 in grant funds across 48 projects to expand capacity within licensed residential care facilities, recuperative care sites and permanent supportive housing. CDSS has also awarded 249,000,000 in onetime allocations to 35 counties to preserve existing licensed residential care facilities. And Orange County has received funding through this program. As part of these county allocations, Orange County has accepted 9.3 million in operating subsidy funds for residential care facilities and 13.1 million in capital project funding to help the local facilities avert closures.

CDSS's Community Care expansion is intended to complement the Behavioral Health Bridge Housing Program and Behavioral Health Continuum Infrastructure programs administered by DHCS. So, a couple of quick notes on these programs and what they've been able to do for Orange County and then I will close. The Behavioral Health Bridge Housing Program is a one time investment of 1.5 billion in over two years to support various bridge and transitional housing settings, and this includes assisted living and senior care settings.

The program also enables qualified entities to purchase and install solutions like tiny homes. So county behavioral health entities, agencies and tribes are eligible for behavioral health bridge housing funds and are now in the process of implementing solutions with the first allocation of $1 billion. And through this process, the County of Orange's Healthcare Agency was awarded 31.6 million in bridge housing funds.

A second allocation of $265,000,000 statewide will be made available through a competitive application process, and counties will be able to apply to that later this winter. So, finally, one last key investment. I'll mention the Behavioral Health Continuum Infrastructure Program, or BHCHIP. This will provide $2.2 billion in funding to eligible entities to construct, acquire and expand properties to provide behavioral health services or invest in mobile crisis and crisis response infrastructure. So to date, DHCS has done five rounds of funding and awarded a total of $1.7 billion.

All competitive eligible entities for this program include counties and cities, but also healthcare providers, both nonprofit and for profit, and our tribes. So the previous rounds focused on crisis care, mobile access planning grants, launch Ready projects, and projects focused on children. The remaining round of funding, round six will focus on unmet needs so very open to whatever other projects, localities or providers want to put forward. DHCS will release the first round six RFA in January 2024.

And so for Orange County under the BHCHIP, entities have been awarded over $38 million in grant funds for behavioral health treatment solutions. So with that, I want to thank you all again for the opportunity to share those updates on a few of our housing and homelessness programs. And we recognize obviously that we have a lot more work to do to fully realize the promise of these initiatives.

But we want to affirm that the state has made historic commitments to ending homelessness and I think really importantly, we've made commitments to holding ourselves accountable in new ways at both the state and local levels. So I want to really acknowledge and applaud the tremendous efforts that are underway in the localities represented by the members of the Committee. Everyone is working to implement new solutions for Californians with mental health conditions and homelessness.

And DHCS looks forward to continuing to partner with the Legislature, counties, service providers, our Medi Cal Members and the stakeholders represented here today to create meaningful change. Thank you again and happy to discuss or take questions.

Thank you. Before we go into questions, if somebody was interested in a copy of your presentation, can we get that out to people?

Yeah, we can clean that up and send it to you afterwards.

If you are interested, make sure you leave your email with us and then we'll move into questions from the panel and then we'll take it to questions from the audience. But before we do that, let me first thank the City of Buena Park for allowing us to host this here. I see City Manager Aaron France back there. I also see Council Member Joyce Ahn. I see Council Member Connor Traut, Council Member Susan Sonne here from Buena Park. Let's give them a cheer.

And I also see Trustee from Centralia I'm sorry Lamiya, tell me your last name again. Hoque. Sorry, anyhow, just that they are taking their time on a Monday Tuesday to come out. Let's thank them for that. All right, go ahead.

Yes, I have a question and first I want to thank you so much for your presentation. I think that you cover a lot of detail and I really appreciate that you explained to us a few programs and initiatives. So my question to you that according to OC [inaudible], we all know that only a referral have been made today for the care core services. So what do you expect the future outcome to be when this program is fully executed?

Yeah, thank you. I don't have projections in front of me for care court utilization, but do want to acknowledge your point that the program just launched and so there had been only one referral, I think at one point when the state had reported out. We do expect that to pick up.

There's been an enormous amount of effort to educate members of the public care providers to work with the county who is administering the program, on how the program works, how to file an initial petition, who is an appropriate candidate for the program. So we have a lot of resources out there and we do expect it to pick up and serve more people.

Thank you.

Thank you, Chair. And thank you for your presentation. It's timely. I need use the word accountability. So I want to kind of sort through all the numbers that you gave. We have heard in the last year that the state has spent $21 billion on homelessness over the last few years. I think it has four years. So my first question, how much of all the monies that you just described is part of that $21 billion? I'm just trying to get my arms around this.

Yeah. So I can't speak specifically to the 21 billion figure. I know, as we do, the budget summary each year, as you all know, we sort of retally what's been spent on housing and health care. And I can say that a lot of the programs I just covered are included in when the Governor does those sort of roll ups of housing related funding.

So back to your word accountability. Can you give us data? I mean, a lot of money is being spent and a lot of good programs that you've created and initiated and are now implementing, how has it affected homelessness? I don't necessarily see it, where there's a decrease in the number of homeless. I mean, you know the number better than I. I think it's over 100,000 homeless people are in California. I heard 170 at one point and in all of our communities.

So I don't know where the money is going. And so how do we measure you don't have to tell me where it's going so much as you've just described it. How do we know it is working? That billions of dollars are having an impact in reducing homelessness. And I'm delighted to hear you could also please address this question. You talk about the linkages between MediCare and people who are homeless. Do you have the figure on the top of your head?

What is the average Medicare payment to a person who is experiencing homelessness? How much money does an individual get and what they do with that money? Is that for food and shelter? Shelter. You talked about shelter programs. I'm just trying to get my arms around where is the money going, how do we know it's working and what impact is it having?

Thank you. Yeah, I'm going to back up and try to start with your first question, which was, how do we know it's working? And I think we have obviously, DHCS has and will be publishing more data on numbers served with all these programs, right? Where what facilities are being constructed, what types of services have been offered. But what I think I hear you asking is, are we actually seeing reductions in the numbers of people experiencing homelessness?

And that is challenging to measure, but we want to measure it as part of our MediCal program. So we are looking at, for example, with the BH Connect new initiative that I mentioned. When we have independent evaluations done of some of these initiatives, we will look at metrics related to housing status and that would hopefully allow us to share some information about MediCal members, specifically how many were unhoused or at risk of homelessness coming into our programs and then what their outcomes were. Right?

Did they end up stably housed?

So we really don't know.

Right now I'm not aware of state, like, statewide figures on reductions.

Is there any statement you could say in the last three years, we know that we have removed x number of hundreds, thousands of people off homelessness. Do we have visibility on that type of progress?

I think we can follow up with numbers related to the specific array of programs, if that's helpful.

Okay, just another related question to the MediCal. I did not know that MediCal is helping homeless. I think people without homes and shelter. That is great. As I said, what is the average medical benefit that goes to these individuals? I've never heard that statistics before. How do we qualify people to receive MediCal payments? And do we certify their residency? Are they California residents? Because I know from the cities I represent and data shows that they come from other states.

Do we have a qualification for serving first California residents, or is that not acceptable? Or are we serving everybody? But I'm sensing that they're coming to California because of these wonderful programs. And then are we helping people even if they're not even a resident? How are we helping people if they're going to be coming? How can we treat them successfully?

Yeah, thank you for circling back on the MediCal part of the question. And I actually wish I'm realizing one thing I should have brought. There was a new study recently released by researchers mostly affiliated with UCSF that talks a lot about the basically characteristics of people who are homeless in California and describes the percentage of people that are from California and fell

into homelessness, which is actually a majority, but has a lot of other interesting to your point, a lot of other interesting data about who's experiencing homelessness and why. So I would love to share some of that with the Committee if helpful. As background, I don't have it here. For MediCal, as folks know, this is a state and federal program that covers an array of healthcare services and eligibility is based on several many different categories disability, status, income.

And so our MediCal program is for California residents and there is an eligibility process that people go through to enroll, verify your income and other characteristics, and then once you're enrolled, you're eligible for the package of healthcare benefits we have. And I think a lot of the programs I jumped right into sort of stats and details, but if you pan out, the bigger picture is that we haven't necessarily over the last few decades, leveraged everything that the Medicaid program can do to address homelessness.

Medicaid won't pay for housing directly, but it will pay for a lot of things like housing navigation, temporary or transitional rent, tenancy supports, that kind of thing. And so there's been a big push by DHCS and our state leadership in the last 5 to 10 years to bring these housing focused services into our MediCal program and make them available to as many people as possible. And part of that does include getting people enrolled right?

And going doing things like street outreach so we can get people connected to services.

Thank you for all the detail to your questions. Maybe the second hearing that we have in a few months, we could get an update on some of the data and know how this $21 billion and rising numbers are really helping. You've got the great programs. I commend you for creating the programs. Are they being utilized to really reduce homelessness in our state? So thank you very much.

Thank you.

No, go ahead and answer.

Thank you so much for your time. Obviously, we're looking, like I said, the programs, we're looking at about $2 billion. Putting there a couple of questions for that. Number one, we already see how hard it is to get healthcare workers right now. So we have all these programs. Are we staffed for these programs ready to go?

Thank you for asking that question. And I think a lot of your other panelists are probably going to talk about this. We do have a statewide healthcare workforce shortage or crisis, particularly for behavioral health providers. And so in conjunction with the behavioral health and homelessness interventions, we are funding a lot of workforce development through the Department of Healthcare Access and Information. That would also be an interesting panelist to have here, so they could talk about some of the workforce development programs that they're doing great.

And then also, we've been working with Sober Living for probably 12 years when I sat on City Council. A lot of the panel right here, and I know that when it comes to Sober Living homes and licensed homes, we've got great, great, good actors out there, but there's always the bad actors.

And I think we had maybe nine to 11 people that were in charge of going through the state and coming and checking on these facilities to make sure that they were following the rules and taking care of the clients and the patients. And we've been trying to increase that. And that was something that Orange County tried to do is actually do a pilot program.

And I think it might have been the Assemblywoman where we tried to even say we will pay as a county to have someone here in Orange County because they're all coming from Sacramento. When you would think when we have so many here in this county know we would have our own. That's something I'd like to see if we could continue doing as you had worked so hard for in the past and then also with the Care Court.

Does everybody know exactly what the process is with Care Court and how you become are able to put somebody into Care Court? Raise your hand. So if you could maybe kind of explain to them how this works. Again, this is a new program. I think there's five or six counties that are working on this

I'm gonna have the next panel's on the county go ahead and do that so we can stay on schedule.

Okay, great. Then I'll go do that. So thank you.

But great question.

Thank you.

All right, before we wrap up this panel, I know that we are going to go from public, but I do want to go back to one of your comments, because on the transitional rents over the decades, we've seen that preventing homelessness is much wiser than having somebody fall into homelessness, get an eviction on their record, and then trying to kind of get out of that.

And we know that many times it's the first and last month and also the rental assistance to keep people in their home. Can you expand on what this transitional rent program would do?

Yes. So MediCal managed care plans and County Behavioral Health will be able to choose to offer this to their members, and folks will be eligible if they're either experiencing homelessness or there is a HUD definition for being at risk of homelessness, which is actually fairly expansive and encompasses a lot of sort of housing instability for various reasons. And so we definitely are wanting to target that population that isn't homeless yet, but may fall into homelessness.

And the managed care plan will be able to, in conjunction with a lot of the housing navigation and other supports because we want to move people into permanent housing, pay up to six months of rent using MediCal funds.

So to me, that is definitely a new emphasis that I think is pretty powerful. I know right here in Anaheim, we have the Anaheim White House who is a restaurant owner, and he works with what we call the motel families right near Disneyland. And he has said that if we have individuals that are in fact paying to live in a motel and they can make that rent, which is a weekly, and they can afford that, why can't they then move into a residence?

And it has been in fact that five-to-ten thousand in assistance that they can't save so I can't save to move to the next step. I think this is a major bright light, at least in some of the information. So I'm appreciative of that. With that, we want to, If there's anybody for this particular panel, for the state that has a question, we'll go ahead and entertain that right now for this panel, and we can come back to questions at the end for everybody. All right.

With that, we thank you and appreciate that. If you're interested in her presentation, make sure we have your email. Thank you. We are just joined by my colleague next door, the happiest place on earth. Welcome, Assembly Member Avelino Valencia. Would you like to make any comments.

Just very briefly?

Really appreciate your leadership on this specific issue, Chairwoman Quirk-Silva, and look forward to a productive dialogue and see how we can improve mental health not only in Orange County, but at the state level.

All right, so our first panel focused on California State overview and our second, we're actually on number three. We will move to number three item addressing the crisis support for homeless and mental health. And we will hear from Brooke Weitzman, the Executive Director, Elder Law and Disability Rights Center, who is an advocate for homelessness. As I mentioned at the beginning, former Council Member Michelle Martinez will not be joining us. Welcome, Ms. Weitzman.

Thank you. Thanks for having me. Advocating for ending homelessness, not providing homelessness.

Yes.

So I just wanted to start with kind of a framework of what we're talking about when it comes to housing and homelessness. Our focus for today, of course, is on mental health and the intersection with homelessness. But I want to make sure we're remembering that that is a very small fraction of the unhoused community, that the significant majority of newly unhoused people currently are seniors, that women over 50 are the fastest growing first time unhoused individuals.

And so when we're looking at this, there's kind of more than one question to ask. The first is who's unhoused now, and who's chronically unhoused? And how do we help this community and what portion of them need these mental health services? And the second is how do we stop the flow, what people sometimes refer to as the silver tsunami of seniors and others into homelessness?

How do we ensure that domestic violence survivors fleeing are not ending up unhoused, that children aging out of foster care are not ending up unhoused? Because all this important work we're hearing about and all the state investment in solutions, if we're not keeping up with the flow, then getting all the people who are already unhoused into housing is still not going to reduce the number. So I think it's important kind of context wise to be thinking about kind of that big picture.

And when I focus back on folks living with mental health conditions, again, there's kind of two groups. There's those with severe and persistent mental illness, those whose mental illness may have led to their being unhoused and then there's folks who have mild to moderate mental illness. They qualify for different programs by different providers. It's a confusing system to navigate, at best.

Our office is often helping people figure out who's the right provider to call and how do they get an appointment and when they're unhoused and the next appointment is three or four weeks out, how are they going to know when to go back? How are they going to find their case manager if they're already unhoused without a phone? Especially for older adults, sometimes losing capacity. It's very easy to get confused and miss dates, and often if they miss an appointment, not for lack of trying.

Our healthcare agency is doing everything they can with the funding that's coming through, but it just can't meet the need of people who are currently seeking everything from therapy to ongoing treatment for severe and persistent illness. So as you kind of heard, housing is inextricably intertwined with health care, that health care fails, that studies often show that people who become unhoused develop multiple chronic health conditions, whether that's physical health or mental health, pretty quickly after losing their housing.

It's often only days between becoming unhoused and moving from kind of how do I solve my problem to a pure survival of how do I eat today? Where do I go today? That folks are walking into our senior centers every day because we don't have a door in every city where a person can walk in and ask for help. And so I think That's one of the questions is when people are seeking help, where is the door?

That especially in a large county like Orange County and part of LA. How does a person looking for help if they don't have a phone, if they do have trouble with technology, where can they walk in and ask for help? And how can we make sure that the day they walk in, they get to sleep inside and get help? Because we're not there. We've made immense progress, but we're not there.

And I think I would be remiss if I didn't at least touch on, as you heard, that, of course, some of what we're looking at is stemming from race and gender issues, from systemic racism and historic racism, that we still have restrictive deeds, restrictive covenants on deeds they're, of course, not enforceable anymore. But that means people who are alive today bought their homes at a time when race or religion determined if it was okay for them to live in the neighborhood they bought their home in.

So when we're looking at kind of the broad population, in addition to the challenges that you've heard about, and I touched on briefly, there's, of course, the stigma, right, that when a person becomes unhoused, particularly older adults that we work with, there is embarrassment. There's fear. They are afraid to try the services, and they don't know how to navigate the system. There's not that door. And so they often initially start living in their car, using a gym or a storage unit to be able to shower.

And the longer folks are unhoused, the more likely they are to develop these chronic health care conditions and increase trauma from that that we saw back when United Way and UCI did a study specifically to Orange County and again in the Northern California study, that the significant majority of the unhoused community here is from the area that they live in. That the significant majority of the unhoused community financially costs a lot more to meet the healthcare needs.

And so we know that the way we solve this is housing. There's no doubt with the volume of research we have at this point that the most cost effective, the most humane way to reduce homelessness and to meet the mental health care and physical health care needs is housing. And so the question really is how do we get there? What is the path from where we are to adequate housing?

I think one of the things that we look at, that we've seen shifting over the past decade, but is still a critical factor, is what are the actions that we're taking statewide and locally and what are the intended results? So, for example, with criminalization of poverty, we've seen courts kind of time and again point out that the 4th and 8th Amendment protect people's right to not have their property season destroyed, to not be punished for unavoidable behavior, that that would be cruel and unusual.

And so that sets some boundaries on what is lawful in terms of crimes like eating or sleeping outside or having too much property outside. But there's an even bigger question, which is what is the intended result? Because we've also seen that even when there are some criminalization tactics that are lawful, they don't seem to have the intended result.

If the intended result is better health care, more people living inside, less people living in the park, then when we have these housing oriented outreach first programs, we see those intended results. When we have kind of criminalization tactics, it's frustrating for everyone from the law enforcement on the front lines who didn't really sign up to be chasing around folks who have a health care need without the support they need.

To the jail that's cycling people through for a few days at a time, to the case manager who then can't get people approved for housing because of their extensive criminal record for minor infractions. To the court that's spending a bunch of time and money trying to collect fines and fees from folks who are living off fixed incomes like Social Security and can't afford to pay the fines and fees.

So kind of at every level we see the ways in which those tactics don't really have the intended results. How do we get the intended results? And I think That's the tough question is what are the steps we're taking? How are we maximizing the programs that the state is offering to bring together health care to bring together housing? We see programs like Home Safe fabulous idea.

This is a program the state put down to ensure that there is money for older adults to maintain their housing and get into housing. But we still have a lot of work to do on the execution to make sure that we're spending all those dollars.

To keep every person who qualifies for Adult Protective Services because of their inability to meet their own needs, that they know about the program, that they can enroll in the program, that the program is adequately staffed up to get all those individuals the help that they need. From mental health care to physical health care to housing programs like Home Key, the idea of buying up and converting buildings is a critical step to getting adequate housing.

But making sure that we're doing it in every city, that in order to meet the need, we can't decide that one city is going to build the housing and another city is not. And then people are just going to have to stay unhoused or move that. Our community needs to come together on how we are going to ensure that people can age in place. Because if we want to continue to age in place, we need to make sure our whole community can do that.

And that means having housing at every affordability rate, that if a person is unemployed because of a disability and they have disability income, we need a place where they can continue to live in their community. And that means access to affordable housing and making sure we're maximizing other state resources like state land. That when we get to the real challenging question of where do we develop places like the Fairview Developmental Facility, right?

That we have a facility, we have a building, that there's plenty of other state land throughout this district that we could turn to and say, are these places that we could develop some level of affordable housing? Are we doing everything we can to maximize available programs? Because we are building in our community, but we're building a lot more high end housing than affordable housing.

And we have amazing developers here who do affordable housing in fabulous buildings that fit in with the community, that maintain the integrity that are not bringing any of the fears that people have about impacting costs of their neighborhood. Or impacting the community in negative ways that we see every time that these well done facilities that offer housing with onsite services are only improving neighborhoods.

So what are the steps that we can take from the state and then from every city to ensure that we're maximizing the development? So, just to wrap up, I will just say that we have seen enormous progress over the past 10 years. We've seen kind of a shift from an idea that those people don't want help to recognizing that we do not have adequate services to asking the follow up question when you hear services of, well, what type of services was that?

An older adult who was only offered a congregate shelter in a warehouse with a bunch of folks they don't know, or an aged out foster youth who had been the survivor of violence that was scared to go into shared living, or a person with a severe mental illness who'd already been kicked out of the shelter for mental health related behaviors. And did we have an appropriate service for them?

Did we have a non congregate place where they could get care and support in a private room that was safe, a place where they could recover enough to figure out whether they can go back to work or whether they need more services? And so all these paths kind of lead to the same place, which is how can we, as a community take these programs that are started and really maximize them?

Reducing the criminalization, recognizing what goals will get us to the intended results or what actions will get us to the intended goals and increasing that access to housing and using every available tool to do that.

Thank you. Thank you Brooke. All right. With that, we'll open it up. Back to the panel. Any questions from this side?

I think this is going to be a familiar theme. We have great programs that the state is the taxpayers are paying for. How do we get them into the right hands? I mean, the agencies and the nonprofits. It's a tremendous ecosystem of caring public and private agencies. And where is the disconnect now?

Help me understand, do you see there's recently signed into law the new legislation relating to the definition of gravely ill for people who need help and have not been covered under existing law so they can be taken off the street and getting into the care. Have you looked into how this is going to affect many of the programs and services that you're talking about?

So I think you might not love my answer to this. I think the Care Court program is going to have little to no impact on housing and homelessness. It's not really targeted at solving homelessness. It's really targeted at helping families serve a family member who has severe and persistent illness that we already have in the state, a conservatorship program.

And for those who don't have a family member who's prepared to try and do that, or whose family can't afford the lawyers and the process to do it, they already were not the public guardian wasn't taking action. That program itself isn't meeting the need. And that's in large part because they don't have anywhere to place someone, even if they were to conserve.

So I think the Care Corps, to me and in the programs that I've seen starting to develop, the real measure of success for Care Court is going to be, were they able to match families that applied to Care Court with the right providers? Because often the challenge is really connecting them with the services that the system of care doesn't give them a path to get there. We'll see.

But I think there will be probably a lower number of unhoused people who are able to voluntarily enroll in a care plan because without that housing stability, even if they wanted to do the care plan, they wouldn't be able to get to all the appointments, they wouldn't be able to maintain it. I think for that general program, the first question is going to be, do we have enough services that when someone comes to Care Court that the court can say, hey, have you tried this?

And so far, while there haven't been a lot of applications yet, so far it seems like the answer has been the court's doing a great job referring people to the right programs that they didn't know about. But the challenge really is what's available more than what are people willing to try?

Do we have any again, going back to accountability and understanding the scope and depth of the issue, how many seniors in Orange County are unhoused? Do we know that data?

So I'd have to pull up what last year's point in time count is. But we also know, the point in time count is notoriously undercounted. It's a very different number when you ask, say, CalOptima, how many people over 60 they served who reported that they were unhoused versus how many people were found? And particularly because that's a community that hides better that I think our senior centers each have a little bit of a sense of the people who are coming in there.

Our libraries often have a sense of the people who are coming in there. But I don't think we have an accurate count on how many people over 60 are unhoused or how many people over 60 are on the brink of homelessness and reliant upon religious facilities to help with food so they can pay their rent.

You mentioned senior centers. Is there any coordinated effort amongst all the senior centers that are the front lines on dealing with seniors as well as coordinating with the food service like AgeWell and other entities that are delivering food to house seniors, but they also can have the first line of defense to see where a senior is going to be needing more care. How is that coordinated?

We're seeing, especially over the past year, the food providers really starting to try to come together to build broader networks of communication, to build broader networks of food delivery. But at this point, even when they find someone who they know needs more assistance, who's at risk of not being able to pay their rent, we don't have the system in place where they can call and find that. Senior rental assistance to maintain their stability that they can with the Home Safe program.

They can help someone call into Adult Protective Services to report what they would have to call self neglect to qualify. Inability to meet their needs. But then there's a slow process of APS deciding whether that person's qualified and making a referral. The state did allow APS to do presumptive qualifications, but That's just not how it has worked so far. And then once the referral is made, the nonprofit gets assigned the case and then they work their way out.

And that may or may not be before the eviction starts.

Thank you.

So we can see this is very complex and, okay. You have a question?

Yes.

All right, go ahead.

Yes, I want to have a a follow up to Assembly Member Dixon. Is there appropriate capacity to shelter for senior population in this county? And if not, what is the unmet need for the population? For this population?

No, there's not. There's almost no emergency shelter Irvine and south, you know, a couple of churches that help here and there and a Laguna Beach shelter. But for the most part, the south portion of Orange County doesn't have emergency shelter. And the reality is that for this, and there's inadequate in the north too, the need is definitely not met. And that particularly for older adults, congregate shelter is really not a good fit, particularly for first time unhoused older adults.

That the question is how can we build programs using motels, houses, temporary facilities, even with a roommate, but how can we build out a program that's going to feel safe enough? We saw when HomeKey started and when all of the pandemic related hotel based programs were implemented, that an unprecedented numbers of older adults came seeking help.

Because going into a private room was less scary than going into a warehouse with 200 people they didn't know and next door beds of people they didn't know when they had never experienced that before.

Assemblymember did you have one?

I want to thank you for your presentation. So some of the big things I'm hearing continues to be that to really look at who the homeless population is and I think breaking myths is really an important part of this conversation, which is many times we're talking about mental health. And you said that, yes, there are individuals on our street that have mental health issues, but it's not the predominant number.

It's seniors, mostly women, that are becoming, so I think one of the questions you asked early on was, it doesn't look like really any dent in this homeless population, and in fact, it feels like it's growing. Can you address that in what you see?

I think that it probably is growing, but not because we're not getting some people into housing, just because we don't have the prevention piece down, that we don't have enough assistance. Things like receiverships right, that we have often older adults who are living alone, who often develop mental health related conditions, that those manifest in things like hoarding, hoarding disorders and depression and that those lead to conditions that cities feel they need to take action about and those folks can't afford lawyers don't have the assistance they need.

Cities end up having to sell the home to replace things. And those homeowners who were older adults alone end up unhoused for the first time at 70 or 80, despite having had a home. There's a lot of paths through which people lose their housing, particularly given the unprecedented costs of everything from food to gas.

And so until we start to cut off those paths, whether That's through rental assistance, through limits on rent, through programs to provide better services for people to age in place, even things as simple as medical directives and end of life plans, making sure that seniors have access to those things that we are at risk of seeing. The numbers continue to grow despite the fact that we're taking really important actions that are getting people off the street.

As you can see, just with our second speaker here, we could spend a lot of time. We want to stay on the schedule, but we will have other questions. And if you stay, there might be some people that continue to ask more questions. Let's thank Brooke Weitzman. Next we're going to move to panel for the county perspective, we will be asking Kelly Bruno-Nelson from CalOptima to please join us, Executive Director of MediCal and CalAIM.

Barry Ross, Executive Director of Justice Partnerships Sisters of St. Joseph. and Dr. Veronica Kelly, County of Orange Chief Mental Health and Recovery Services. You each have 10 minutes, but if you want to, you guys choose how you want to use your time, but we can also go back and let's go ahead and start with Kelly Bruno from CalOptima.

Good morning. Getting close to afternoon. Thank you very much for having me. And I would agree with you, Assemblywoman, that we could talk about this forever. So I'll do my best to stay in the 10 minutes and let you know some of the things that CalOptima Health is doing to address the unhoused issue here in Orange County. Let's talk a little bit, I'm going to move through this as quickly as possible if my slide will allow. Okay, here we go.

And there it goes. Faster than I wanted it to go. Maybe we won't do this. So CalOptima Health is newly into unhoused services. More so because of CalAIM. So what is CalAIM? And you heard a little bit about that from a panelist before us. The CalAIM really is California's recognition that our ability to be healthy is 80% determined by things outside of the hospital, outside of the traditional healthcare system. Things like housing, things like food, transportation, safety.

These are things that now make us more healthy. And we know that. And this is California's recognition of that. And that is what CalAIM is attempting to address. Why is this important to our unhoused population? Quite frankly, it's housing. Now, for the first time ever. I'm going to drop this.

Now, for the first time ever, we know that services that have to do with housing an individual are covered by MediCal. Assistance in identifying housing, assistance in maintaining housing, and assistance in the deposits necessary to get that housing. These were not things that MediCal was not covering before, and now it is. This is groundbreaking for unhoused population and groundbreaking for California, and it's exciting to be a part of that. What are those services? And I'm really sorry, my slides are not working.

What are those services? They really go into five different areas. The first is recuperate. Now it wants to work. The first is recuperative care, which, you know, is for individuals that are exiting hospitals that need assistance in gaining themselves or getting back from what was ailing them in the first place. There's also housing navigation, which is helping individuals identify housing.

Housing deposits, which gives up to $5,000 for individuals to pay first and last month's rent, possibly back, utility bills, et cetera, so that they can get that housing. Also housing tenancy. Those are services that allow folks to remain housed. So you can see that MediCal is looking at how do we identify housing, how do we secure that housing, and how do we maintain that housing? These are all now services that were not covered by MediCal. That are now covered by MediCal.

I wish you could see the numbers, but I wanted to share with you some of the numbers of those that we have served through this service. Here we go. There's the services that I mentioned. How many have we served thus far in our CalAIM services? There it was. And there it went. zero, thank you very much. Here we go. Okay, thank you very it's good to have friends in high places.

So here are the services so far that we have provided since 2022, since January, when this started. And you can see the number of individuals that have been helped through those services and the dollars that have been invested by CalOptima Health. I think one of the panelists earlier had mentioned that the count that we have here in Orange County is more than likely significantly underrepresented. And you can see through these numbers that that absolutely is the case.

I think it would not be fair to say, as amazing as CalOptima Health is, that we've served every single unhoused individual in the county. That is certainly not the case. So we are definitely seeing a larger number of those that are unhoused and what that count represents. Next slide, please. We also recognize and appreciate that our ability to provide these services has to do with the number of folks in the county that provide them for us. We don't provide those services directly.

We are not a direct service provider. So we are dependent on the kindness of strangers, if you will, dependent on the providers in the county to be able to provide those services. And so we invest in the service providers in the county in four different ways. I want to mention that the dollars that we use for this are dollars that are earned from the Department of Healthcare services based on how many individuals that we house and how many individuals that we serve.

And then we're able to earn investment dollars that then go back into the community. We put them into permanent and affordable housing. We've recently invested over $74 million with 21 organizations helping to build 1175 affordable and permanent supportive units across the county. We've also assisted in those facilities or in those organizations building capacity to provide those services.

I think you heard from a couple of other panelists that our ability to provide the services is directly connected with our workforce issues and our workforce that's able to do that. When CalAIM became a medical benefit, it wasn't as if our community based organizations had capacity that they were just waiting to use, that they weren't saying, I always say 75 social workers in a closet waiting to come out and provide services.

That's not the case they don't have that capacity, and we have to give them the infrastructure with which to do so. We also wanted to invest in our inequity issues and to invest in organizations that may be helping the most marginalized of our community. And so we've given away $3 million to 32 organizations in that space. And then also looking at system change. How can we make large system changes across the county that will help everyone? Next slide, please.

There's a few other innovations that I want to mention briefly besides those benefits that come from CalAIM, where we have invested. We have invested in a program with Chrysalis, a workforce development program. One thing that we identified, That's been identified here is that we do have a workforce development shortage. We have individuals that were previously unhoused that have that stigma associated with that or that are coming from the justice system and need a job. We also have a homeless shelter system that needs folks.

How can we marry these two things together and train individuals with lived experience to be able to work in those shelters? And we invested in Chrysalis, and we've done just that in the first six months of the program. We have found jobs for over 25 individuals, therefore finding jobs for folks, and also increasing the capacity of the system. We also have invested in United Way to try to do what was earlier said by Assemblymember Davis. How do we make things go full circle?

How do we fill the gaps where gaps exist? So there are sometimes small things that are needed to be funded that hold a person back from getting housed, whether that be registering a pet. Sometimes it's sometimes these little tiny things. And there's no exact fund that will fund that. We gave United Way dollars to do just that, to fill in all those gaps, to do literally whatever it takes. We also have a Pulse for Good Program.

I'm not going to go into that, but I will go into one that's not mentioned because we spent so much time earlier speaking about the Silver Tsunami. CalOptima Health created a program that is specifically for older adults experiencing homelessness that combines recuperative care specifically for older adults 50 and over with PACE.

And we had identified a building in Tustin, and we're trying to build that be the first in the county, the first in the country to ever create that program, unfortunately, because it is a new entitlement, something that's not housing, something that's not a shelter. It doesn't fit anywhere. And so because of that, we were unable to get the building and unable to utilize it for that service. This is a problem.

This is something that we need to address and something that we would like to create here and need assistance doing. Next slide, please. Very quickly I'll talk about street medicine. As you know, I'm sure we've launched street medicine here in Orange County. Our first city was Garden Grove. We provided its primary care on the street, working very much in collaboration with O and E with the county to provide primary care proactive care to individuals on the street. It's a canvassing approach utilizing individuals with lived experience.

We have just recently purchased a support center in the City of Garden Grove, a hotel. We'll provide 50 individuals in that program with a place to stay until they can get permanently housed. And we are looking to expand that program into two additional cities. I know my time is up. I could speak forever, like I mentioned. Thank you very much for the opportunity.

Thank you. And we have just joining us Assembly, I mean sorry,Senator Janet Nguyen. And would you like to make a comment?

I do. First, I want to thank Madam Chair for hosting this, especially in Orange County.

Is that mic on?

Okay, now it is. I want to first thank Madam Chair for hosting this in Orange County, because this is an issue that we've all been asking up in Sacramento. And everybody who I've met in my district has been asking what has been happening, what is going on, and are they doing anything at the county level and whether the state legislature should actually start looking to see what has been helped?

Because I don't think anybody in Orange County can ever say that the homeless population or the mental health issue has gone away at all. And billions and billions of dollars has been spent by the State of California. So there has been one person. I might be wrong today, but if there's anybody who can tell me that everything's perfect in Orange County and then there's no more homeless problem, please let me know, because I have been looking. No one's been able to say that.

I want to ask a couple of questions for the presenter. That the slide that you had in terms of the data and the cost that you're spending in regards to the units, you spent $74 million for 1175 units, and then on top of that, you spent $24 million for other organizations. Is that $24 million? Okay, so that $24 million. Is that part? No, the other one.

Go back.

Go to the other slide. That slide. So there's four tabs on the bottom there's, $74 million. The other three equals to $24 million. Does that include. Is that part of the $70 million?

No, it's not. So the slide previously were all services. So because MediCal now pays for these services, on the other side, the $28 million is dollars that we are infusing directly to nonprofit organizations, actually 140 of them across the county to provide those MediCal services that I identified. So those are just like reimbursement for services. These dollars are separate. These are dollars that we've earned through the Department of Healthcare Services to basically be a pass through to give back to the community.

And these are the four areas with which those have been invested. So those are in addition to, not reflected by the first slide.

So the 24 million, are those the services for those who are seeking help within the $74 million units?

Some are and some are not. So some organizations provide services like PSH and permanent supportive housing, so we can help them build their capacity to do that. But then you also have other unhoused services like navigation or tenancy other things that need to be expanded, and those dollars are helping them do that. Like I mentioned before, we have capacity issues when it comes to service providers because now this service is available to everyone. And these community based organizations need help in investing to build that capacity. And that's what those dollars do.

Of the 1100 units, how many folks are permanent and how many are just coming in and living there and then moving out and living there? But what's the ratio of permanent versus revolving door tenants?

Sure. So you can see on the slide that it says we've invested with 23 organizations. So CalOptima Health itself is not building these houses. What we're doing is we're finding projects or funding projects that are already underway here in the county that need that extra UMP, to get basically from third base to home. As I like to say, the vast majority are permanent supportive housing facilities, most of which, if not all, have not been completed yet.

We have funded them to be able to get them over the finish line. This funding is brand new. All of this funding has been given in the last nine months.

How many of the 1100 has been built already?

Oh, none.

None? Okay. Do you have then, a measure for these organizations going forward that they will report to CalOptima and the county and maybe also to us as well, the state legislative body of the difference between permanent housing versus revolving tenants?

Because I think it'll be helpful for us to know, because I know there's a lot of discussions about the navigation system, but what I'm finding out about these navigation system is that we don't know how many individual actually is seeking help at these navigation versus the same person who's been there 30 times that month. So that's now counted as 30 people on the data and not 30 individual. The navigation, they're supposed to help as well.

But I think, though, is for us in the state side, for us to continue to help with the funding we want a permanent solution and not just revolving door. And so I think as you're moving forward, if you don't have that, I think asking the nonprofits to be able to track this and provide it to us would be very helpful going forward.

I appreciate that. I will mention that permanent and affordable housing is not navigation center. So these individuals, most of which will have vouchers and they would be staying. But I appreciate that we'd be happy to help.

Yeah, no, I'm not saying that these are navigation. I'm saying an example of what I'm seeing as an issue for us is not knowing the amount of money we put in these navigation centers. Are they helping permanently or we're just having revolving doors and just one person, like I say, can visit their 365 days for the year, and that's counted 365 people.

Sure.

Okay, I think we're going to move to our next panelist or we're going to be here till one or 02:00 in the afternoon, and I don't want our last panelists to be left alone here. So with that, we're going to go to Barry Ross, who is Executive Director of Justice Partnerships, Sisters of St. Joseph Healthcare Foundation, but has worked extensively in North Orange County as well. Mr. Ross.

Thank you, Sharon, for inviting me and for being able to share a little bit about what the Sisters of St. Joseph of Orange are doing around addressing homelessness and some of the challenges that we have. So, next slide.The sisters have been in Orange County for 101 years, and they still see themselves as striving to be courageous, compassionate, and a transforming presence in our beautiful, wounded world. There are 88 sisters here, but they're working with many other people in the community to make a difference.

Next slide, please. So I want to share three of the efforts that the congregation is doing. The first is the St. Joseph Justice Center. We have a housing advocacy team made up of sisters and laypeople that are focusing on policies and services that will hopefully help end homelessness and create more affordable housing.

One of our efforts shortly will be to convene the faith communities in the City of Orange to look at Senate Bill 4 that was just signed and try to see what opportunities there are within the city to encourage congregations to produce affordable housing. We have been focusing a lot on the City of Orange to try to encourage more affordable, housing friendly policies, and we continue to advocate for that. The next slide, please. This is a picture of the motherhouse on Batavia and Lavita.

This building is now being converted in a partnership with Mercy Housing to 50 units of affordable housing for seniors. 16 will be for permanent supportive housing for people with mental health issues. It's a real symbol of the commitment of the sisters to convert part of their campus. To address this need, they partnered with many organizations, the county with MHSA, the City of Orange, and others to make this happen. It's taken, I think it's eight or nine years.

It's going to open next year, which talks a lot about how challenging it is to build affordable housing. This is a renovation. The cost per unit is $750,000. So we really have to look at that, I think, the cost to create this, what will be beautiful, affordable housing. Next slide, please. So the Sisters of St. Joseph Healthcare Foundation is a health plan conversion foundation that provides grants throughout Southern California, Bay Area, Northern California, Humboldt County.

We are going to be focusing in 2024 primarily on families of McKinney-Vento eligible children in six counties in California, one which will be Orange County. An opportunity I see for the Legislature is to look at the McKinney-Vento funding. Currently, my understanding is it's a pass through from federal government to the state to counties because the state does not match the funding. In Orange County, there's only four school districts that have been able to compete for funding.

So we have many school districts that cannot add benefits to serve these families that are either homeless or at risk for homeless because there's limited federal funding and no state match. So it's something I'd encourage you to look at. Next slide, please. I borrowed this slide from the Family Solutions Collaborative. And Carrie Buck, their CEO, is here today. But it really points out what are all the many factors that bring people to homelessness. And the larger the circle, the bigger the issue.

And I know you're all familiar with these, but we're trying to address all of these issues, and That's why it's so complicated, because it's not one easy solution, but definitely affordable housing is the big solution. Next slide, please. So we were asked to talk about needs and solutions. And my question at the top is really, is there the will, both as individuals and organizations that we are part of the effort to stop hundreds of people dying on the streets of Orange County each year?

New families on the streets every day because of lack of shelter and people living in shelters for years because they can't find a home. I think that there's a lot of organizations that would say, we're part of this solution, but we're not there, and we know we're not there. So, some thoughts I have. First of all, affordable housing. We talked about it, but what would be the impact if every city in Orange County had an inclusionary housing ordinance?

And if Orange County passed $1.0 billion bond for affordable housing, we have to do more. So, to give you an example, over the last seven years of the last housing element, a city, Irvine, had an inclusionary housing ordinance. They produced 1149 units of very low income affordable housing. Orange did not have an inclusionary housing ordinance. They produced nine units in seven years.

Many cities do not want inclusionary housing ordinances, and I understand, but if we don't have it, how are we going to produce the housing? Secondly, we heard about eviction prevention and diversion initiatives. I was proud that when I was with Providence, we helped start an eviction diversion collaborative in Orange County. That United Way now is leading. But what would be the impact if every family facing eviction had an opportunity to pay back the rent or have legal representation in court.

That's what it's going to take to prevent people from coming into homelessness. Third, person center coordinated services by name for those on the street. You've heard a lot about all the programs. They all have case managers. They have housing navigators. They have all these people. But what we really need, I think, is one person assigned to each person that will really do everything instead of one homeless individual having 12 case managers, because every program has a case manager that they contact.

Can we organize ourselves more efficiently to coordinate? And can every week a team go over what's happening with this person? Where are they? What do they need? How do we get them to that service? There are solutions. Other communities have done this. Why can't Orange County do it? And lastly, we know we need affordable housing that's permanent. But we have people on the streets now. And if it takes eight or 10 years to create a project, how do we have interim transitional housing solutions?

I'm honored to be a Commissioner for the Buena Park Housing Navigation Commission. Every quarter when we meet, we look at the data of the people in our navigation center. About 10% are placed in permanent supportive housing. They all have housing navigators. There's no housing to place people into. So people stay for years in these centers that are not designed for that, and people are on the waiting list to get in. We have to have other solutions. We have no safe parking program in Orange County.

How do we have people that, lots of people are living in their cars and vans? How do we make it more dignified for them if we don't have a safe parking program? We don't have tiny home villages. We need other short term interim solutions now to get people off the street. And my last slide is just homeless people are not the problem. They are the result of the problem. Thank you very much.

Thank you, Mr. Ross. Any questions, or are we going to stay on track and let our last and then we ask questions at the end? All right, now we are going to welcome Dr. Veronica Kelly, County of Orange, Chief of Mental Health and Recovery Services. Thank you and welcome.

Good morning, Chair and honorable Committee. You guys are going to put my slides up, right? So I'm going to speak about the county behavioral health system. And just an important reminder that the county's role is to provide specialty services to people who have MediCal. That's what we do. So if you have a serious mental illness, you have a serious emotional disturbance. If you're a child or you have a substance use disorder and you're on MediCal, we are the ones who serve you.

If you have a mild or moderate mental illness, our partners at CalOptima are the ones who serve you. And then we are also the safety nets. If you have no coverage, we are also the ones who are going to be serving you next slide.

So we serve approximately 40,000 unduplicated clients a year. 40,000. We count them each once. Of those, about 20% tell us that they are unhoused. And for us, that definition means they don't have a permanent place to live. They are couch surfing. They are living in their friend's apartment with them, they are living in a family's garage or they are living in emergency shelter. It does not mean for behavioral health that they are literally unhoused. It could mean that, but That's not the definition.

Our system really looks at prevention, early intervention, treatment and recovery support. How do we keep people who are dealing with a serious mental illness or an addiction from falling into our streets? Our services are for the most part voluntary. They are outpatient services, but we also have the inpatient system and we do have involuntary services. Assembly Member that you mentioned, the gravely disabled. So we also are the ones, the behavioral health director and statute.

Myself, I'm responsible for every 5150 written in this county not done by law enforcement. Senate Bill 43 will change that effective January. We are not prepared for those changes. So my recommendation to our Board of Supervisors is deferminate until 2026. That will allow us time to come up with the state a license for a locked substance use disorder treatment facility. No license exists in the state.

There are currently no places that actually would accept co occurring disorders, a physical illness, a serious mental illness, and a substance use disorder illness that are locked. So we are going to be deferring that. But that will have an impact certainly on service delivery. Next slide. So we have over 400 programs that serve people who have medical who have a severe illness. About 200 of those we contract out. So unlike CalOptima, we are a provider and we are also a network.

We know that the more people who receive care, the less likely they are to fall into being unhoused. And That's our job. So I'm going to talk about a few things. Our full service partnership, housing and outreach and engagement. I do want to take a minute to talk about care act. So Orange County is one of the first seven cohort counties. I would say that we are leading in this regard. We have received nine petitions to the court.

Of those nine, we've received five-minute orders to do an evaluation, an engagement, find people in the community. Remember that responsibility. Once a court finds prima facie, falls to me to have my staff go out and locate an individual. A clinician is going out into community, knocking on a door, or looking under a bridge to find somebody. We have 14 days to engage them. And what we want to do is engage them in voluntary care.

That's going to be the most effective at whatever level that they need. This is for people who have untreated schizophrenia, spectrum disorder, or related psychotic disorders. They must be unlikely to survive in community not being treated and also not currently being treated. And so that court process requires someone, anyone here could petition their family Member or a friend, go to the court, you fill out the paperwork, you can do that e-file or you can do it physically there.

Our self help counters at the courts have been trained on the process. Then you have to also have either a signed declaration from a licensed clinician that the person has schizophrenia or proof of two episodes of severe, intense need for treatment. And That's been defined as 252, most recent being in the last 60 days. It is a very small window of people who are going to get in here. Being unhoused is not a requirement in all of the treatment that the county provides.

We always address housing, that is always part of someone's service plan. So we have, like I said, nine petitions, five orders. We have court dates. Two court dates are happening today. We have one on the 20 eighth, one on the 17th. These are private, these are closed sessions because this is about health care. So That's where care is right now. Next slide. I want to talk about our full-service partnerships.

This is a requirement for the Mental Health Services Act, as you all will recall, the millionaires tax. And it says that 51% of dollars I have in one particular bucket. Community support services have to be used for full service partnerships. The governor's office. Health and human Services and Mayor Steinberg have talked a lot about Orange County's program. We spend 45% of all of the money we get for the Mental Health Services Act on full service partnerships.

And what we've seen the mayor did an op-ed correlating that with our drop in our point in time count over the last two years by 17%. What we are doing is pulling people off of the waiting list to get into housing and getting them treatment. Someone who is unhoused with a mental illness or an addiction, we want to treat them, that will help them get off of the street in immediate housing via treatment, and then we can move them off.

The important thing is to get those folks treated and not have them languish on the streets. The full service partnership is whatever it takes, whatever an individual needs in order to be successful, we provide it. We pay for that through the Mental Health Services Act. Doesn't matter if it's billable or not, we will just provide the service. That includes transportation, helping their families, relocating them. Shared decision making happens here. It is not about us dictating what a person should do.

We need to know what a person wants. We can help them achieve that and what we've seen. The focus of this is to reduce psychiatric hospitalizations, incarceration, homelessness, and the most important, to reduce prolonged suffering. Next slide. So this is accessible, this service 24/7, 365 days a year. There's a caseworker, an entire team of people who work with someone who has a serious mental illness, who's in this program. They are individual services. Here it's equity-focused. The focus is on outcomes and accountability. Next slide.

In order to get into the program, you have to be unserved, underserved or homeless or at risk of being homeless. And you must clinically be in need of services. And this is voluntary. Next slide. These are all the services here that are offered in a full service partnership. And the highlighted ones are the ones that are directly impacting being homeless, which includes housing support, intensive case management, rental subsidies, house payments, transitional and temporary housing. All of our full service partnerships have housing attached to them.

Those are actual homes where people live. Our outcomes really important. Next slide. We pull information and give it to the state. The state has actual data from every county on their full-service partnerships. I think the difficulty is just getting it back out to all of you. Next? Yeah. So we serve 63% of the folks in our full-service partnership are male, 37 female, 42% Caucasian, 32% Latino API, 13% African Americans, eight and 6% other. Next slide.

And so here are our outcomes, the most important things when someone is in a full service partnership. If we're looking at fiscal year 2122, the column to the right, they have an 85% reduction in hospitalization, 86% reduction in going to an emergency Department. They have an 86% reduction in being incarcerated.

They have 95% of the folks who are in a full-service partnership have no arrests for being addressing our unhoused people in a full-service partnership, 80% have no days unsheltered and 84% have no days in an emergency shelter. We know that full-service partnerships work. Next slide. I want to just talk a little bit more about some other services that we attend to with housing and with behavioral health.

So the Mental Health Services Act has provided funding for permanent supportive housing in this county since 2008. We have participated with our county partners in Office of Community Resources and Office of Care Coordination and have built 400 permanent supportive housing units throughout Orange County. These are specific for people with a mental illness. So we are again pulling our folks off the streets and getting them a different type of treatment and shelter. Permanent supportive services.

Each of these housing projects is supported by a full-service partnership and we also have specific staff who assist them in getting in and out of those services. Next slide. I want to break down where those housing projects are for all of you. So the total MHSA funding we have used thus far $90 million to build housing for persons with a mental illness. And these are all the cities and the units in which they are in currently. Next slide.

These are the funding streams to build that housing. We have some one-time housing, our ongoing programs, our SNHP housing dollars, and then our No Place Like Home that we've pulled down from the state. We have 327 MHSA units that are coming online in the next two years. That will bring us to over 700 units for people who have a serious mental illness and that will add an additional $72 million to our MHSA housing. Next slide.

You heard Paula Wilhelm from the Department of Healthcare Services talk to you about some of those $2 billion that the Governor is talking about. And we are very appreciative for the dollars coming down. We have Behavioral Health bridge housing, and this is really to focus specifically for unhoused or people who are at risk of being unhoused, who have a diagnosis That's served by the county, including a substance use disorder.

And these dollars priority is given for us to build these homes for people who are in care. Some things to know here, we received $31.7 million. You heard that we are adding 120 beds. This has to be short and middle term transitional housing. It's shelter, That's what it is.

We can only use 25% of this to build and I just want to remind you what Barry just said, $750,000 a door for St. Joe's to create housing, we must keep the cost of the 25% to $75,000 a door. We're doing it. We have a number of providers who we are already working with on. We have not received these monies yet. So while we've been awarded and I think That's great that the Governor has done that and gotten the dollars out.

We've not gotten the money yet. We are moving forward, but we don't have the money yet. So we are taking to the board our contract That's signed so that we can then receive the funds which we haven't gotten yet. I think I mentioned it a few times, so That's important. I did want to also talk to you about Behavioral Healthcare Infrastructure Program or B chip dollars. Again, Paula had mentioned that Orange County has been awarded 38 million.

Of the 38 million I just received, the 10 million, the $10 million we have is for the Bul campus in Irvine that will support two crisis stabilization units. That's eight beds for youth, 16 beds for adults, and a sobering center there for 12 sobering beds that we will use quite often. Our next round of Behavioral Health Bridge housing comes out in the next month.

And so we are going to be it's a competitive process, which would have been great if it weren't a competitive process that we could just draw it down. Takes a lot more to pull that sort of thing down. I did want to mention some of the difficulty with these types of funds. They are one time only funds and they're not sustainable. We have to figure out a way to make them sustainable.

So for B-Chip, That's the 38 million we've gotten, we have until 2026 to expend those funds, and so have folks build with those funds. In order to get these dollars, we had to put up a match. And that means our provider has to put up a match, 25% cash or their property. That's a difficulty for a provider to have to put up their property as the match. And that means the County of Orange is on their deed until 2026.

And they have to also agree that they will serve the medical population for the next 30 years. These are not our normal housing providers. These are treatment providers. That's a difficulty. Behavioral Health Bridge Housing. We have to expand it by 2027. Same thing. Deed restrictions. We are on that, and we've been having a very difficult times. You had heard Paula talk about $9.1 million in community care expansion through the Department of Social Services, and an additional 13.1 that the county received.

We are going out for RFP for both of those pots of money in this next month. We cannot get a provider to take this money. And if there's anyone here who would like to talk to us about taking the money, please come talk to me about it, because again, some of those same restrictions are happening. What we found is we've lost about 75% of all our boarding cares in this county in the last five years.

We are trying to build those back, but people can make a lot more money on airbnb than they can in serving someone who has a serious mental illness. Next slide. Our Homeless Outreach and Engagement. This is a team of people, 68 people. They're funded through the Mental Health Services Act, and they go out into the community and they work with our folks who are unhoused.

They work collaboratively with our Office of Care Coordination, with all of our cities, with our public works, and with our law enforcement partners. On average, it takes 10 interactions to gain the trust to actually begin to engage with an individual. We have some folks who will never talk to us that we've tried for years. In particular, if they are living with an active substance use disorder, it's a lot more difficult. Next slide.

So over the last year, our Office of Outreach and Engagement, That's in the Department of Behavioral Health, we have conducted 7125 outreach sessions to 23. 289 duplicated clients because they move a lot and takes a number of interactions. Of those, 6668 agreed to accept a referral for services. 31% had a confirmed linkage to services. We follow them up to see did they make it. We actually take them to places, make sure they get to their first appointment. Do they get to a follow up appointment?

53% did get access to a referral for healthcare services that was confirmed, 14% to substance use disorder confirmed, 25% to shelters confirmed, and 40% to other housing referrals. Next slide. On average, it takes five quality interactions with an individual just to start to engage. And if they have a serious, persistent mental illness, it can take 10 just to engage, not to get them to do anything, just to engage. And if someone has an active substance use disorder, it takes seven.

This is important because it's about the time none of us would be willing, if you just met me today, for you to go with me somewhere, get in my vehicle and go get you something. None of us would. People who are living on the streets are just like we are, only they're far more traumatized and very suspicious of us because, as many of my colleagues have stated, we haven't done the best job in this space. Next slide.

It's important that if we're going to interact with someone, we have to give them something. They are not going to talk to us. Giving them hope is not going to help when they're living on the streets. What we found is we have to give them something and we have to have the ability to get them to a service. I can offer them a lot. You can come and see me on Monday. But it's Friday. What am I supposed to do in the meantime? Next slide.

So really important. The thing that has been very effective is handing out naloxone Narcan so that it's needed on the streets. Everyone has a friend on the streets. They use that. That's been very helpful in getting people to interact with us. It's hard to get someone to get substance use disorder treatment if they don't have insight and then they're agreeable to treatment if there's housing attached to it.

They do not want to go to treatment and live in a shelter, which is a very disconcerting place for many of the folks that we use that we are working with. And next slide. And that is all I have. So happy to answer any questions.

Thank you. All right, it's a lot of information. We're going to go ahead and go to questions panelists. Just remember that we are on a timeline here and we want to get the public involved as well.

Thank you, Assemblywoman. Excellent presentations by all three of you. As we know, when we started first thing this morning when we heard from the state, and we still don't know how many billions are really being filtered down to the county, but I will say it appears that Orange County I can't compare with any other county, but you seem to have your arms around all this. There's still some the I'd like to know how much money you get from the state. How much does Orange County get from the State of California? Is there a real number?

So my budget yeah, my budget is $750,000,000.

And then how much does the county supplement that?

The county gives us about 2 million. The rest we have to raise by pulling down federal financial participation for billing the feds. About 350,000,000 of that is Mental Health Services Act. We have a couple of federal block grants. We don't make money, we lose money.

So compared to other counties, I mean, in the city, in Sacramento, we hear of a wide variety of struggles. I commend you. It seems like you've got your arms, all of you in the county have your arms around a lot of issues. Is the number one issue. Obviously, housing, That's what everybody is leading with. And there are different kinds of housing that people need. What can we do to respond to the housing other than what we've already done?

I mean, many of us have sat on city councils and have been dealing with homeless now the homeless housing crisis for over five or six years. How far along are we to getting permanent supportive housing as part of the solution? You've got the programs, all we've heard the state, the county programs and we've got partners. Where are the gaps? I know it's a hard question, but what can we focus on? Because you've got the elements, you've got.

The Assembly Member will have her answer and then the other two if you have some ideas.

Yeah, I would say in this county we all work together very closely. Our board is very supportive. Our CEO works with all the cities. The cities are working directly with us in Behavioral Health and I know they are as well with our partners in CalOptima. But this takes time. We can get to this place overnight. And there's a pressure for us to get people off the street so folks don't have to see their suffering.

And while that I understand that it is a longer process, we need time, we need staff. We are in Behavioral Health. I have a 20% vacancy rate. That's down from 30. We've done amazing in the last two years. But 20% vacancy rate for licensed Clinicians when schools churn out 40 at a time who are master's level, that is a problem. So we are expanding our workforce. But That's also a difficulty because in county at least, and That's why we rely on our partners.

We are labor, we are unionized, and it is difficult to work for us. And we are working with the most severely ill people. So people who are working for the county are 100% mission driven. We could all make $1.0 million more anywhere else. But we need a workforce. If we had a workforce, we could do more of these things. And talking about the money we have for workforce, That's great.

But we need to see people being churned out of schools, whether it's an AA degree or a drug and alcohol counselor or a licensed psychiatric technician. We need all levels of healthcare.

Barry, Kelly and you don't have to make remarks if you don't have anything to add.

Just to say that there are other communities that have ended homelessness for specific populations. I think we need to decide what's our priority, populations that we want to focus on and then come together as a community to say, how are we going to end homelessness for that population? There are solutions. We just need to implement them here in Orange County.

Kelly. Homelessness is a complex problem. Like I said before, it requires a complex solution. I do agree with looking at a specific population. We've heard several times about the Silver tsunami. The fastest growing unhoused population are older adults 50 and over. California Health attempted to help to fix that problem, tried to build a $28 million building and put $20 million into renovating it. And because it was something new, something folks had not heard of, we were not able to do. So those paths have to be available to us. If we're going to invest $50 million in something specific for the fastest growing population, we need to be able to build it.

Why weren't you able to do that?

It's an entitlement that no one's heard of. It's specifically for older adults. It combines pace with a specific recuperative care that looks like an assisted living. It's semi private rooms with private bathrooms. It's not a shelter. It's not housing. It doesn't fit neatly into anything that this county has ever seen. And because of that, we couldn't get it entitled and we couldn't build it.

Who didn't give you the entitlement?

We were working with the City of Tustin to get that done, and unfortunately, we couldn't have it. But I don't think that they're unique. This is a unique problem. The space has changed. Those that are falling into homelessness the fastest are older adults, and they're falling into homelessness because of economic reasons. They have physical needs that are different than the regular unhoused population. They can't go to the shelters we have here. They need an assisted living like you and I would know.

We have to build that. We were willing to do so. We had a building. We were investing $50 million, and we couldn't do it. That's a problem.

So a new model and a no from the council. Okay, Senator, and we want quick questions because we want to get to our next panel, I think I'm sorry, Assembly Member Tri Ta.

Oh, yeah. I really appreciate that. I'm really impressed with the presentation from all the panelists and especially Dr. Kelley mentioning about the outreach program and interaction. So I really want to know that for the patient with severe mental illness, how can you keep them to go to appointment and also able to check in and for 5150 patient not referral by the law enforcement? So what would be your solution for that?

So if a person is involved in any of our programs, especially the full service partnership, they have someone who will help take them, who will go with they sit with them in the appointment just to make sure that they get through it like many of us would like to have happen. With regard to the 5150, what was the specific question?

So for 5150 patients not referral by the law enforcement, so what would be your solution?

So, if somebody were a danger to self or others are gravely disabled, unable to find food, clothing or shelter because of their mental illness, we would write a hold. We take them to a designated hospital site, including our crisis campus at the Be well and then they are attempted to be stabilized for the next 72 hours. If they can't be stabilized, then we can extend that hold for two weeks.

And the idea is we have a lot of folks who need a higher level of care and we don't have those beds because where we used to have people be treated was the state hospitals. And there's a 2500 person waiting list to get into the state hospitals that now are serving our most ill. Mostly folks who've committed a serious crime.

All right, just a quick follow up on that question from me and then your next Senator. If we're having local jurisdictions say no to many parts of our issues related to housing, what about county land or state land? Are there any opportunities there? So for example, you just mentioned this new model that sounds innovative to me. Is there any county or state land that that project could be moved to or identified that we're not?

So I don't know how many parcels we have in the county. Although I do know we are building on the Irvine parcel where we have the Bewell campus. And That's part of this is what we're trying to do. Get people treated there, including residential treatment for substance use, disorder for youth, as well as for pregnant and parenting moms. There are additional land there, but I don't know how that operates.

I do know that as far as the state level that Assemblymember Ramos was able to get passed a Bill so that we could use some part of Patton State Hospital's land for additional housing. But I don't know any more than that.

Because we have the campus in Costa Mesa of Fairview. I know they are doing some emergency operations, but it is 118 acres. So just stating here, if there's ways to look for county or state, I mean, maybe it isn't in Tustin, but there's other areas that we can start to identify to streamline some of these processes because we all know that this has been one of the barriers. All right, Senator.

Thank you. Madam Chair, just a couple of questions. First one is how can someone get into this program?

Full service partnership. We receive referrals from everywhere people can call. Our number is out in community. Most of our referrals do come from family Members. Our law enforcement partners all aware. All of our hospitals know. All of our homeless providers of service are aware. As well.

Can you provide that number for the rest of us on this panel up here so that if we have constituent who calls in, we have access to that information?

Of course.

Second question is, you had a slide that talked about the different ethnic group. One, you had API as 13%. I know you probably don't have the answer today. Can you break that down to tell us what of those subgroups are? So it'd be more helpful for us because then we would know where the concentration of specific areas depending on the ethnicity.

Yes, of course. And the concentration is the highest concentration is going to be Vietnamese. I did want to note that we did just open a Vietnamese full service partnership. It already in the first week, had 12 people who were part of that full service partnership. So That's an important point. I'll make sure you get the breakdown.

Next I have is you mentioned just a follow up from Assembly Member Dixon, you said. So your annual budget is it 700 annual budget. Right. So it's annually plus a 300 federal draw down in excess. You're about $1.0 billion a year.

Yeah. And put it in context. One person going to the state hospital costs $1 million a year from the county. Yeah, That's what we pay. Remember, if a facility is freestanding and it has more than 16 beds, we need help with this one. Then the county pays for all of the cost of service. Medical does not reimburse for that. We pay for that. And that comes out of our budget, the $750, which is state funding. It's state and federal because we're drawing down FFP and we have a couple of block grants in there that's Federal.

Because you mentioned the county puts in $2 million of that annually. My last comment, Madam Chair, is all these slides. Can we get them after this? If they can be sent to our offices so we can have them, yeah. Thank you.

Okay, thank you. Before. Let's see. We're going to go to Assembly Member here Assemblymember Laurie Davis. Wait, don't leave. I think or do you have one?

I do. Okay. And I'll try to go as fast as possible. Thank you so much. Number one with Ms. Bruno-Nelson. With the 24 organizations that you're using the funding to, what is the process for auditing? So is it a yearly process? I just want to know where can we see those numbers.

Specifically for the housing?

Yes.

So we actually just hired an external auditor That's going to be looking at all of our grants. All of our grant processes are very transparent. We put notice of funding opportunities out to solicit those organizations, but then we do internal auditing and then we have an external auditor as well.

And is that meant it's out there for the public to look at?

I believe so. I mean, the outcomes of those will be the units. Being built. I mean, That's the outcome of those capital dollars. Those were capital dollars that were given to build. So the results of that will be will those units be built? So That's what we're looking for as far as an audit is concerned.

Okay. And I understand that there should be something though, like if you go to the state, there's an audit, there's something you can look up to see where did the funding go, how many houses, things like that that we as the public can actually saying yes, the housing, what's built. I want to be able to look at on paper and go right, this was actually built, when did it start break know and how many did it house? That's what I think would be great for transparency, for the public to see something there.

I think that's a good idea. I'm sure we could work on that.

Thank you. And then a question for Mr. Ross. You were talking I'm on the sit on the board of the state allocation funding for schools, and so I know you were talking about state funding and these programs for McKinney-Vento funding. Yeah. Is it the McKinney?

McKinney-Vento funding for children that have been identified as homeless, according to that definition?

How can I get more information on that?

We can get you that.

Okay. That'd be great. Thank you. And then last, I have Dr. Kelly, we have in regards to care court, again, I was conservator of a mentally ill family Member, and this was back when you could actually get them off the street. And I think that if we look back to policies that have been changing over the last 40 years, it explains a lot of where we're at at this point. I know that mainly this is voluntary. How do we get it?

Okay.

Yeah.

Because we can put somebody in treatment for a month and then they go back in the street and they're back where they're at. I mean, when you have addiction and you have mental health problems, it's a lifetime management, and we have to make sure that they are there. We've got treatment for them for the rest of their life.

How do we get to the point that we can literally get somebody off because they aren't of sound mind to be able to make these decisions, whether they're addicted to drugs or they've got schizophrenia. And again, you're the experts here, and I just want to say our job as legislators is to make good policy.

So the number one thing is when we're looking at housing is affordability and we have to look at making sure that the price of gas is lowered, we have to make sure that the cost of housing in CEQA is mainstream and fees aren't that high. We have to make sure that we have help for daycare. All of this is our responsibility up here. And I'm going to tell you, you've got a great panel here that have served this community.

We need to make sure the rest of the Members up there understand that it is our job and our responsibility, and I take that very serious here. And the one time funding, That's all good, but what happens is we've got a deficit and a budget. And once we go and we keep giving one time funding up there, it means that the next year, when we have a deficit of $30 billion, they're not going to get it. So you've got a program now here sitting.

What's going to happen? We've got to look at the audit. We've got to sit there and say, this is working. This isn't working. No more money. And we're going to give money to projects that are moving so they can continue to go forth. And so I thank you for what you do. You can see I get very angry and frustrated because it is our responsibility and we can do more up there.

And what I'm hoping is if you can give us policy that you think will make a difference, I know this panel that we will sit down together because we've got a great group in Orange County that we actually meet and say, how can we fix things together for problem solvers? Let us know what we can do. And we will stand strong for every single person here. Thank you.

Thank you, Assemblymember Davies. I just want to say that to that getting ongoing funding as part of regular course of business for the Public Guardian's office would be a huge start. It's not funded now. We have a Bill That's a law That's opened up our conservatorship office. We don't have the ability to Fund that. And also to get all of the different departments to talk together for licenses.

I have to wait and have three different departments, public health, DHCS and Department of Social Services all run their own licensing for one facility and none of them speak. So to do that would be very helpful for us.

Well, you are speaking our language. That's exactly why we're having this. So again, following up not only with the public out here, but if there are specific pieces of legislative fixes that you think that we should take on, please communicate with our offices directly because as was mentioned, we do want to do what we can. I am now in my fifth term as a Legislator and I've realized over these years sometimes it's a tiny fix.

So when you mentioned licensing, I know that Be Well has been waiting Orange County Be Well or right, the Orange campus of Be Well, not the new Be Well has been waiting for a license. So please contact us because I know all of us would be willing to either make a phone call or write a letter, but we need that direct information to take those steps.

But again, we're all entering another legislative year and if you have something, we do get some criticism that the state is telling the locals what to do to knock it off. I'll speak for myself only. We are happy to knock it off if people are moving forward with what they need to do to be part of the partnership to solve homelessness and mental health issues in Orange County. With that, any other comments before we move to our last panel? Thank you, everybody's.

All right, we are heading into our last panel here, and we have some panelists here that are going to talk about best practices and provider perspective. As we know, we talk a lot about what everybody should do, and as a former classroom teacher, I know exactly what that means. There's a long list of everything that people should do, and yet we're not the ones doing the service.

So sometimes talking firsthand to those people who are providing the service gives us an inclination of where the gaps are, where the barriers are, what is going. Well, I hope there are some examples of good things, but I'm really excited to welcome this panel. And we have on this panel Kellee Fritzal, Executive Director of the Hope Center, which I'm proud to say is located in the City of Fullerton. You'll explain what the Hope Center is.

We have Dr. Pooja Bhalla, the CEO of the Illumination Foundation, which I'm a tiny bit biased, but also in the City of Fullerton. And then we have Benjamin Hurst, the Managing Director, the Center for Applied Research and Innovation of the Salvation Army of Orange County. And I know you're going to share your opening of a few weeks ago. Welcome, everybody. We will go ahead and start with Kellee Fritzal.

There we go. Sorry about that. Thank you, Chair and Members of this board. I'm going to start with how we were formed. So, next slide. So we're going to talk about North Orange County Service Planning Area. The county created three different areas to focus homelessness, to really make sure we're providing services and people are receiving services near their homes. So this was a really tremendous help for us. We're in the North Orange County Service Planning Area. Next slide.

So the North Orange County Public Safety Collaborative was formed in 2017 and this was through the input from city managers and police chiefs with both Senator Josh Newman and actually Assemblyperson Sharon Quirk-Silva. So the cities came together and they focused on three areas: homeless prevention, youth recidivism, and I'm going to focus on homelessness. Sorry, I hate public speaking. I'm great at questions and answers. I'm going to nail questions and answer for you guys.

The collaborative does provide funding to 11 cities and 48 community based organizations. And what I need to let you know is all the CBOs are audited every single year. Their audits are on the North Orange County Public Safety Collaborative's website and you can see Boys and Girls Club, anything, what they do, where the money is spent. So we really, the collaborative is really about transparency and accountability. I've heard that a lot today. Next slide. So how did the Hope Center come about?

In 2020, again, we were using one time monies. The collaborative was afraid that we were not going to get any funding, but they really did like the collaboration and the breaking down of silos. So usually as an outreach worker, if you're a Fullerton outreach worker, you ask that person, what are your ties to Fullerton? If they have no ties to Fullerton, guess what? The outreach worker moves on. Well, That's not what we're doing in North Orange County anymore. We are helping our homeless on the street.

So that was the concept of the regional outreach and that's how the HOPE was developed. Brenda Park was a leader in this. So Brenda Park was the first city to join with Orange County with Fullerton, and we did a pilot project. It worked. We have just been doing dispatch calls and I'll get into it for a minute. We've expanded to Stanton in Brea and next we're going to be in La Habra, Placentia, Cyprus and La Palma. So we cover some of your areas.

So what is the HOPE Center? Next slide. We're about collaboration. We work with the county. We work with all nonprofits. We meet every Tuesday and do client coordination. So we don't have those clients falling out. We have a beyond the lookout on our app. So county will say, hey, we're looking for somebody and we're like, we'll go find them. VOALA is part of a lot of our services. So we are working together collaboratively. We do coordination. We're working with Caltrans.

We go out and we do the outreach before they do a cleanup. Because, Caltrans, they do a cleanup, the homeless comes back. So where you have a cleanup coming next week, we're going out. We're doing the outreach. We reserve beds for that day of the cleanup, because then we can get people into the shelters. So this is the way we're collaborating with and coordinating with both state, local, and county in the county. And I'll tell you, CalOptima, and they've been wonderful. They're at our meetings.

They're helping us out. But we're also data-driven. We have outreach grid next slide, which coordinates it. So how this works is we have PD transfer calls, homeless calls, non-life-threatening homeless calls up to the HOPE Center. Then either we go out with PD, or our homeless outreach workers go out alone, and we respond to those calls. It is more appropriately to have non-PD respond to homeless calls.

So our mantra is, I'll talk about that a lot, but we really do track our clients, and so we don't have them fall out. The key is a client can have you've heard it five case managers. We can oversee. We know who they are. We talk to them. All of our staff have each other's cell numbers, and that includes county, and that includes all of our nonprofits. Next slide. Reducing the Police Department response to calls is huge.

This way, the Police Department can do what their true mission is, and we can do the meaningful street outreach efforts. It is trying to create trust with our clients. That is the number one goal. Next slide. So our mantra is right people, right resources, right now. And that is key. Who can bring the best services to our clients? It might be our HOPE staff. It might be county, it might be CalOptima.

But if we're going to do something, we break down the silos of city boundaries, we break down the silos of the county, and we collaborate with all nonprofit agencies. Again, we want to reduce the response to homelessness by the Police Department. At the HOPE Center, we meet weekly, as I said, to do the case management. This has resulted in, in August, seven of our clients being placed into getting housing as soon as it's developed.

So, again, the key is working cooperatively, getting more shelter beds, getting more permanent supportive housing. And that is it. Thank you very much.

All right, next we have Dr. Pooja Bhalla, CEO of Illumination Foundation.

Well, thank you, Chair Silva, and Assemblymembers, for this opportunity to really hear from the front. As for us, for providers, what we're witnessing on a daily basis, if we can go to the next slide. We've heard a lot about all the wonderful services that are available to our unhoused individuals. But we at Illumination Foundation have really worked on meeting the clients where they're at.

And as a result of that, we've built a system of care that's called "street to home." And just to go back several years, you'll see on the slides here, our goal is to bring folks in whether they're out on the street, coming into a shelter, provide the medical services through recuperative care, with a goal to get them into permanent housing. And I really want to start by thanking DHCS and our health plan partners because it truly has been a partnership.

Last year alone, we were able to serve 6500 individuals. Prior to that, years before, we were seeing maybe 1000 clients, 1500 clients. We worked on wonderful programs through foundations like UniHealth who allowed us to bring homeless individuals in and hold on to them through the street to home model because we know it takes a good 18 to 24 months to get them into housing.

Prior to CalAIM, we did that through programs like High Utilizer Programs, working on those UniHealth Foundation grants, but that only helped maybe 300 clients at the time. So with the environment that we're in, it really has been a partnership working with the health plans to bring folks in. But what we saw is that we had to build a system of care internally.

There's wonderful hospitals, large systems in our county, but for the unhoused population, it is very difficult for them to navigate going from the street, from the shelter, take four buses to maybe go to a clinic and then go to the pharmacy and pick up the medication and where are they going to store it? So medical respite has really been a godsend for our population, and we've been able to help a lot of clients through that. I also want to talk a little bit about families.

I'm part of the Executive Committee at Family Solution Collaborative and I worked in Boston for many years. And there was a question asked earlier about any help we need from our elected officials around families. Last year there were 500 deaths in Orange County and two babies. So if I had a magic wand we cannot have family homelessness in Orange County. That is one of my hopes and dreams that we as a county can work together to end family homelessness.

Currently we're seeing at least 300 families that are waiting for housing. There's hundreds of families that are in shelters. We at Illumination Foundation run four family shelters, mainly in the northern county, and we're looking for spots in south Orange County as well. How can we really help families? The stories that I hear every day, we've got single mothers with four children trying to make ends meet, cannot afford rent.

So as part of our system, we've tried really to help everyone who's coming in from the streets provide the medical oversight through recuperative care, get them into housing, and with the goal to get them into permanent housing. Next slide, please. And I'll show you some of our facilities in Orange County. This facility here on the first is our Fullerton Navigation and Recuperative Care facility. 150 bed.

This has really been a complete integrated healthcare and housing facility where folks can come in through the navigation center, through the City of Fullerton. They also can be referred directly from the hospitals into a recuperative care facility. And we also have a medical clinic in that facility on the second floor, where we can offer dental services, primary care services, all in one place, psychiatric services, substance use services.

And to be honest, that is not something we were doing earlier because we were like, we can refer our patients to all the wonderful partners, but for an unhoused person, it is very difficult to go navigate the healthcare system. So we do have this integrated system in the City of Fullerton. And we've served hundreds and hundreds of clients from the City of Fullerton, not just through the navigation center, but also through the recuperative care facility. In the middle there is what you see are micro communities.

That's part of our street to home model. And here we can bring someone in who came through the streets, came through the CalOptima, DHCS-funded recuperative care program, was able to stay in a step down program for another six months.

And we're working actually on a partnership with CalOptima, the healthcare agency and Illumination Foundation, where we can work collaboratively to get folks into housing, because we know once they're with us, we need to really provide them all the services, but they need to wait to get into housing. So we were able to get some vouchers that really helped that population move into housing and not go back out on the street. And the last photo, there is a Carnegie shelter in the City of Santa Ana.

We have about 170 clients there on a daily basis and still clients waiting to get in. Next slide. And a lot of these services now are reimbursed. Prior to Calam, we were very much grant funded and not able to help as many clients. But we're very grateful because we are now able to provide services like helping people find housing, housing deposit.

Through DHCS and CalOptima, if we have a client who has a housing voucher and we're waiting on getting them into housing, it is that first month rent, that security deposit. Through the housing deposit program, we are able to actually make that happen. And we've seen some real success stories in making that happen. And the other programs, again, really build that integrated services that are available for our clients through CalAIM. The last slide.

Speaking about the burden of mental health, I know the slides are hard to see, but you can see we looked at data internally through our CalOptima partners and also our hospital data to look at what the needs are for mental health. And we saw that out of the 1200 folks that we looked at, 91% needed behavioral health services. And about 97% of them have some sort of substance use issue and some other major depressive disorders.

And I can tell you, I actually like to sort of really talk to my staff on a regular basis to understand what the need is. For every 10 clients who need services, I may be able to get one in, and that just speaks to the need. There's a lot of great work happening, but we need more, we need more behavioral health services. We need more be wells, we need more psychiatrists. We, like everybody else, are also struggling trying to hire healthcare staff.

And just recently, we made a decision at Illumination Foundation that we will be moving all our staff to a living wage. We are not able to hold on to staff because our staff themselves, some of them are struggling with homelessness and living in their cars and then trying to just get the services has been really a challenge for our population. Hence, we've built the street to home model so we can really provide as many services as we can. And one more slide.

And this just again speaks to we have a hub and spoke model where folks can come in into our different facilities, and our goal is to get them into housing. And I really want to end by saying thank you for having this panel because it's going to take all of us, public and nonprofits and our elected officials to really help address this issue of homelessness. And again, just a reminder, there's folks dying every day on the streets in Orange County.

And thank you to Chair Silva for really moving forward with the Assembly Bill where we can actually now look at why people are dying on the streets. We will be able to, there's a task force in Orange County that we're part of that's going to allow us to look at individuals that passed away on our streets and see what exactly happened so we can save lives. Thank you.

Thank you. I think we'll go ahead and finish our last panelists and then we'll have questions. Welcome, Benjamin Hurst from the Salvation Army of Orange County.

Thank you, Chair Quirk-Silva, what an honor to be here. I want to respect everyone's time and touch for just a moment on some things the Salvation Army sees as working in the homeless space and also a couple of items that we see tremendous gaps in services. So let me turn my attention there. Next slide, please. Salvation Army is the largest private shelter provider in the United States. With over 40,000 beds, we operate almost 10% of the nation's homeless shelter capacity.

And I mention that to say what we see with communities that are getting on the front edge of the homeless crisis is they're emphasizing a throughput system, putting the pieces together that respond to each aspect of the complex system of homelessness, to put a throughput system that moves people off the streets, through quality channels of care and into either permanent housing or complete community reintegration.

So in Anaheim, the Center of Hope is the 14-acre campus is the national headquarters for the Salvation Army's Homeless Throughput system. And using the diagram that's on your screen, let me touch on a couple items in the homeless services space that are working well. I want to suggest to you state leadership that emergency shelters are over-performing right now.

I think they're working very well in the sense that most of them are at or near capacity, and they are not designed to be long term housing options for the homeless, and yet they are taking quality care of frontline individuals, the backbone of our homeless care services system. And I would suggest to you that the emergency shelter system is overperforming in the state because it's only designed to be a temporary triage space, and it's actually serving as transitional housing right now.

So I would encourage support for our shelter operators. I want to echo what my great friend from Illumination Foundation just said. It is a very precarious space to operate in right now, fiscally, for most homeless service providers because of runaway inflation. Obviously, most nonprofits are smaller, mid-sized organizations. They're not the Salvation Army. So they are very sensitive to changes in minimum wage. They're extremely sensitive to changes in healthcare rates.

Just last week, I heard from a local homeless service provider that their insurance coverage for their team went up 40% this year. That's not unusual in this space. So what happens is they're locked in multi-year agreements, negotiated two, three, four years ago, inflation runs away, and you've got some small mid-sized shelter providers that are in trouble now. You could turn your attention to that from a state level and see if there's any relief that can be sent that way.

That would be a big help to your frontline service providers. Shelters are doing well. There is a huge push for homeless housing. And, of course, at the Center of Hope, we recently just cut the ribbon on 72 new units of permanent supportive housing. I was told it's the largest permanent supportive housing project to date in the history of Orange County. And I wanted to celebrate with our great friends from CalOptima who put $4.1 million into that program, Kelly Bruno Nelson and her team.

So someone asked if any of their units were up yet. We're on the front edge, we're the freshman class, 72 units came online two weeks ago. So that's some good report. And in addition to that, 16 of those units are MHSA funding through our great friend Dr. Veronica Kelly and her team. So there is good things happening in the homeless housing space, but communities, they're extremely nervous, and we know that. I got a call from San Diego community leaders a few months ago.

They said, Ben, we're freaking out down here. For every nine people we get housed off the streets, 13 are falling into homelessness. Talking to some Los Angeles officials lately of course, their situation is nationally known. We're getting 200 people put into homeless housing up there every month. 227 are falling into homelessness. So someone asked the question earlier in the panel, we're doing all this activity and we're generating all this energy. Is it making a difference? Well, it is making a difference.

If you're San Diego and you're getting nine people into housing, but 13 are falling into homelessness, we ask the question, well, what would happen if they didn't get the nine in? They'd be in a really precarious situation. There is things happening. It's just not at a pace that's fast enough. And we're all scrambling as aggressively as we can to light a fresh fire under more homeless housing.

But I want to suggest to you today that from the Salvation Army's perspective, That's not where the battle against chronic homelessness is actually going to be won in this space because we develop permanent supportive housing. As we just said, just cut the ribbon on 72 beautiful units that cost $500,000 each. Only about 30% of the people in our shelter would ever qualify to get in that space.

So we're going to push, we're going to drive, we're going to work aggressively with community collaborative partnerships to get more homeless housing up, more permanent supportive housing up. But That's 30% of our homeless population. The rest have to self resolve another way. And what we are telling leaders, what we're telling community leaders is we believe it's time to turn the attention to the substance use disorder battle in the homeless space.

To believe we can see some quality, large scale, enterprise-level victories in that space, getting people drug free, back to work, housed and serving others as the most likely end result solution to moving the needle on the homeless space in a real serious way.

So to that end, we've been working internally as a Salvation Army team designing a substance use disorder recovery program targeted to the homeless population that focuses on social isolation as a reason for their addiction and customizing the program out of addressing the social isolation aspects to their addiction. We're trying to bring 50 beds online in Orange County and in 2024 as a proof of concept.

And if we can iron that out, we've already committed three acres at Center of Hope to bring upwards of 250 more beds of homeless substance use disorder recovery space online in the next 36 months. Look, we could never begin to do that on our own. That's going to take a community lift.

That's all of us, practically everyone in this room joining arms, every service provider, all community leadership coming together and saying, look, let's place Orange County at the front of the map and make it the addiction recovery response to homeless leader in the United States. I think the opportunity is there. I think the scope of our problem is such of a size that we can do it, we can lead in that space.

We've got the community and collaborative spirit as evidenced here today, and we've got the resources that can meet and match the scope and scale of the problem we're facing. So in the spirit of that, I'll end with this. I was the guest on Angels Radio AM 830 this summer, and they asked me, we want to know about Center of Hope.

So I told them about our base path up there and told them all the outcomes and all the data and all the statistics, but they go to commercial break and they mute the microphones and they ask me at commercial break the defining question of our time. They said, Ben, that all sounds great, but can people really change? Can people really change? And I sat in that studio at Angel Stadium knowing I had about 120 seconds of commercial space left.

And I thought about people I'd met coming through our Anaheim emergency shelter. And I thought about Frank, who was a plumber who had got four DUIs and lost his license. So he lost his plumbing business. So he's suddenly out on the street. So he gets in the shelter, he gets his life piece back together. Today, he's on his own. He's got his own apartment, he's got his plumbing business back. He's reintegrated into society.

I thought about George, who was one time 20 years ago making 120,000 a year managing properties in the City of Irvine, but he got involved in a gang situation and got sent to state prison for 17 years. Look, it does happen. So when they exit him, he's literally on the street. Today, George is rehabilitated, back in society, got a full time job and has his own place. So I'm thinking of these people. We cut back from commercial break, and I lead into the microphone.

I said, "listen, let's be clear about this. 25 years ago, my own sister was a meth addict on the run from the law, stealing to support her habit with arrest warrants in three states. Today she is 25 years sober. Today she is a wife, a mother of four children, and she is the chief financial officer of a hospital in Washington State." This is what I know. We can reach higher. We can reach further. Thank you for your time.

Thank you. Really appreciate that passionate ending of your testimony. And let's give a clap to everybody. Kellee. Dr. Pooja Bhalla. All right. With that, we will open it up for any questions up here, and then we will take audience questions. If you are from the audience and you have a question, not a comment, please line up. It is streaming live. Senator Janet Nguyen, question?

I don't have a question. Madam Chair, if I can just make a few comments. I again, once again appreciate you hosting this and getting everybody together and trying to really bring to the table what the problem is. And I think one thing of this, I've learned a lot today and a lot of data that hasn't been provided to us in the past. But one thing I keep on hearing is that we need more money. More money.

That's the challenge we face, though, is we as a state have seen billions of dollars has been sent down and even the county mental health has $1.0 billion a year. But the result is the increase of homelessness continues in this county. So I'm more interested in what can we do, how can we start moving that direction? We're all willing to support more money, but we can't justify it.

When I go out on the street or in my district and people keep on saying why hasn't there been any changes to homelessness problems? That's the concern I have. And I appreciate everybody, all the panels and all the work that you've done, everybody here there has been progress. But I think we need more than just we need more money. We need to see accountability. We need to know, are these permanent housing? And if they are, have they worked?

If they aren't, then we need to find a different solution because all of us here would not be looking at fixing a car that doesn't work. You're not going to keep on putting money into something that doesn't work. So I think the reality is that we really need to come together. And I also like this Mr. Ross, I think from St. Joseph, the comment he made, or one of the person made.

I like the idea of somehow us getting to the point where one homeless individual or one mental health individual gets one case worker and not 20 or 12 because it really is difficult. Government itself, the agency, are so difficult for us to navigate, let alone someone who don't have access to what we have and don't have access to computers as well. So that system itself in government is so difficult already. And so I like that idea.

Maybe we can kind of come up with ways is to streamline, at least on our end, the state departments somehow. And it's not going to be an easy task, I'll tell you, because we all dealt with them already. But overall, I do appreciate everybody's effort and work that you continue to do in Orange County. But again, I think we need more. And when are these houses going to be on the pipeline, or actually not on the pipeline, built and someone inside it?

Because more and more money coming in doesn't solve the solution. It hasn't looked like it. So again, I just really appreciate you doing this.

Thank you, Senator Nguyen, for joining us, appreciate it.

I just wanted to thank all of our panelists today and as earlier this morning, my first question is where does all the money go? I think all of us have been, as we've served in our various legislative capacities at the local level, dealing with homelessness and now at the state level. What I takeaway is there are many, many fine programs and many people are getting the help that they need. We've built many shelters, just as one of you said, the shelter is not the problem.

We see in our cities that the permanent supportive housing is the next hill to climb. That's the battle. But I am very grateful to the public-private partnerships that clearly are essential to making our communities work and deal with these seemingly intractable problems.

But addressing the specifics, just having been talking about homeless and dealing with this now for over five or six years from the local level now to the state, all of us are learning so much more and how to be more targeted and effective and where the money that is scarce can be best applied with transparency and audits and checks and balances to make sure that the programs are great. We just want people in the programs and get them cured and healed of their issues and addictions.

As Mr. Hurst said, That's really the problem that is affecting all of our communities and to deal with those addictions because those addicted people can't get into the shelters and they can't get into the permanent supportive housing. And so it's this circle that keeps going round and round.

I just want to thank you all for the hard work you're doing, scraping by and looking for dollars for our county government agencies that are truly, you have the programs, now you're making them work and you see where the gaps are, That's where we come in and just we can open up the lines of communication. I know Supervisor Foley has been working very hard on these issues, and as this mental health Bill was going through the Legislature, I was in touch with the county.

How can we make this better? So you retain the excellence, the best standards, the flexibility that the county needs to make these programs work. So thank you for the hard work that you're doing and allowing us to hear about it.

So thank you. All right, any comments? Assemblymember? No.

All right, so I'm just going to make a few comments and then we will take it to the public. And we hear big ideas here. And that's exactly why we hear these type of select hearings. Many times these hearings are actually held in Sacramento, so we don't get to have you right here with us. And that's why I'm a real fan of these select hearings. And of course, because of the pandemic, we haven't been able to do something like this in the district.

So I'm very happy. I want to thank all of the team, from my team to the state team, to, again, the City of Buena Park for hosting us, all of the panelists who have joined us. And one of the things that I always appreciate, whether I'm chairing a meeting or part of a meeting, is that you learn something. So some of the big kind of ideas that I heard is: can people really change?

And I think we can all answer that individually and we have all our own opinions. But bottom line, I think we have to believe that. And that's my opinion. And we have to do everything we can to get people, instead of saying it's all their fault, figure out how to get to the next step. Where is the front door? Where is the front door to services? Imagine you're 60 years old, even 70, and you've never had to rely on any type of social services.

You've never had to go to a government building, and now you're faced with homelessness and you may in fact have some type of chronic health issues. You may have trauma from many ways. How do we make that navigation simpler? And I think somebody said all of us, if tomorrow we woke up, just think of Lahaina, and your house is burned down and all of a sudden you have no documents, you have no ID. You have just the clothes on your back.

How would you navigate a system where, in essence, the county headquarters is in Santa Ana, coming from Fullerton or Newport Beach or San Clemente, getting on buses and all of those things. And so sometimes it's walking somebody else's footsteps. Prevention. I was really excited to hear about this new support for deposits.

And I think that whoever is in charge of that in the county or whoever is administrating it, please let all the partners know because like I mentioned, Anaheim, White House who works with the motel families, they don't know about that. And so if they can get assistance to move out and get a deposit, first and last, or stay in their apartment, that is another way to keep people from falling into homelessness.

And then my final comment, and then we'll open up to the public is one person at a time. We hear many times these types of phrases, but I really think if we can get to the part where we celebrate those individual wins because certainly the ratio for us right now is not what we want. If we're housing nine people but 12 or 13 fall in, we're still behind. But celebrating the wins and getting them to the finish line, which is permanent supportive housing, is a big win for Orange County.

But we also need to focus on every single jurisdiction, from the south to the north, has to do their share. There's got to be equity in this solution. It cannot be the north supporting either the central or south. Everybody has to play a role, including individual cities, no matter how small they are, because it's not fair to the other cities to get that pushed on to them. So all cities have to do something.

With that, we're going to open it up. We're asking for questions, and please let us know who the panelist is. You want to ask the question. So only questions, not comments. All right.

Only questions. Okay.

Questions.

Well, for somebody like me who has a mental health and who's also had homelessness, if you're dealing with somebody who has had suicide attempts and they're overdosed or their brain is not working properly and they're not able to access specific because of that brain injury, what can you guys do to help somebody like that, like me?

So the question is, if there's somebody with a lot of trauma, whether it's a mental health disorder, suicide attempt, what would we tell somebody, a family member that individual, of how they can seek help? What's their first I guess what you would say, where's the first door?

Well, it's not more like, not everybody has support. Some people are alone and not have support.

So we're going to have Benjamins from the Salvation Army go ahead and.

What I'm asking is, like, if somebody has a brain injury, why can't there be more legislation for people with brain injuries? Because when you attempt suicide, your brain gets injured.

I think the system is set up to where you or someone just like you would be warmly welcomed into a congregate or non-congregate shelter system that gives you immediate, trauma-informed, wraparound services while a personalized case worker assigned you then immediately reaches out to Dr. Veronica Kelly's team for more substantive care. I think there is a pathway in place. It does have to be navigated, though. We're sensitive to that.

What if the person has sought service and the people that were supposed to help hurt the person with bad decisions and bad encouragement? How do you become accountable when you're the person causing the issue for the instead of helping?

This is only a little responsive, but I think on disability accommodations and disability rights, we have some work to do that our shelter system, our congregate shelters are not current. They are certainly trying their best. They're making disability accommodations that they're set up to do, but they are not set up to meet the disability related needs of every person.

And so when we're looking at places to grow, when we're looking at the gaps in the system to fill that, we definitely need to do more on specifically disability-related, making sure that we're not trying to train every case manager to be ready to respond to the needs of someone with, say, a brain injury, but that we have appropriate services focused on different needs of different groups so that people aren't grouped together in a place that isn't necessarily prepared to meet their needs.

But I guess I'm not.

We're going to have to move on because we have a line behind you. But we hear what you're saying.

Sorry, it's because I feel like that you guys give a lot of money but that money is not being used properly. And I wish there was a way to fix that so that people like me can say, hey, this person is doing wrong, they're not doing their job right and you guys are giving money to them to do a job that they're not doing right.

And we do hear you on that because I actually did write a piece of legislation that said that if there are providers or shelters that are not treating people with dignity, other issues, there is a place to report that to. Because certainly we don't want to say we have people in shelters and we know that we've heard many outcomes of people who say I don't want to go to a shelter for whatever reason, maybe very bad experiences, all of those things.

So because this is a new space really relatively in the last decade, we know that there's a lot of training, we know there's a lot of safety issues, we know that there's constant work that needs to be done. And as, as was mentioned, we have people now living in shelters really full time for much longer than they were ever intended. I think initially people thought maybe it would be a six month to year.

We know that that's going on sometimes 3 and 4 years and this was not the intent. So we certainly acknowledge your voice out there. We know that there's been some very bad outcomes. I know that there are women who are homeless who have said I won't go there, I don't feel safe. So we have work to do in that space. But thank you for your comment. Next.

Good morning. My name is Council Member Jose Trinidad Castaneda from the City of Buena Park and I have a question on red tape. And so at the state level, I want to know: how can the state move to cut the red tape on some of the seismic retrofitting needs at our area hospitals? From what I understand in Anaheim, there's lots of hospitals that would love to build permanent supportive housing and love to build up.

But the cost of seismic retrofitting can sometimes set that back and I think we can move the needle on building more homeless housing and attached with healthcare if we work on some of these issues. Thank you.

Good question. And the seismic retrofitting for hospitals is something that the state has taken very seriously. It was quite a big issue as one of the things that we want to do is protect some of the vulnerable communities where these smaller hospitals are existing and not have them shut down just as hospitals. We saw one up in Fresno that shut down.

We know there's others that are verging on the brinks of shutdown because of the cost of seismic, but also moving into a more creative type of building which would be using existing hospitals. I know. Well, I was going to say St. Jude Fullerton, but it's now Providence. They are actually housing some of the former sisters there. So they have moved in ahead of housing. I think that we're going to continue to work on that because it isn't just hospitals.

We're looking at building structures, building actually, the former Los Angeles County Hospital with thousands of rooms will be now turned into housing. And so there's reimagining in the future of what do our workplaces look like. As we know, more people work remotely, there's more opportunity. Keeping the cost down per door is also something I know. I've talked to commercial builders who says it's not as cheap as it sounds just to convert a building into housing.

But we have everything on the table as far as how do we look at school sites, how do we look at faith-based sites. By the way, that Bill SB 4 just got signed. Very excited about that because it's going to be a little bit of everything. Some faith based institutions, some educational institutions, some hospitals, some former commercial buildings that we're going to be able to peg off those units that we need. But it won't happen quickly. And you're right, the word streamline is extremely important.

And we have done a lot of streamlining on legislation and we will probably continue to do more unless we have cities stepping up and saying we are going to be part of this solution. And until then, you're going to see more legislation. Alright, next. Hello.

My name is Steve McNally. I'm on an Orange County Behavioral Health Advisory Board. Every county in the state has one, welfare and institution codes, responsibilities, not always allowed to do all of it. I speak as an individual, honorable Chair, and I'll admit I'm a fan of yours. So I appreciate you having a town hall. I think this town hall shows you the difference in the people in Orange County than your last town hall that you had on this topic.

So a couple of questions I would have is why do we accept silos in Sacramento? Why can't we model the behavior in Sacramento that we want the cities and the counties to follow? When will we create a safe space for dialogue? And why does state believe they have the only solution? It's not money. Can you get Governor Newsom to do something with the Fairview property since he has the details on it and OES is just going to be an impediment?

All right, we're going to start with some of those.

And you don't have to respond to all those, but that was just getting them on the table.

All right, generally, why do we have silos Sacramento? You know, we have made a lot of efforts to kind of streamline the big umbrella under housing. We have HCD, we have the mental health, we have so many departments as you know, not only do we have those at the state but we certainly have them at the federal government, county and local levels.

So to get people to collaborate and communicate, that is a work of art and I know, in fact, that's how I actually started, was working with the Fullerton Collaborative over 24 years ago and it's not easy as we say things like, "it's herding cats" because everybody has their own agenda. But we are working. And many times we've asked for accountability and there have been reports that have come out.

I know my colleagues were asking about accountability and the billions of dollars we've spent and there have been reports that have just come out recently that state similarly of we are housing people, more people are following in. So it doesn't look like you're making any dent. Why don't we model what we say? I don't think the state feels like they have every answer.

I've come from local government and now at the state and that is the first thing, I will be honest, that the locals, elected officials get really grouchy. I see three right here and when they feel like we are taking, superseding their local vote, I don't think any state lawmaker, and again I'm speaking for myself, goes to Sacramento to say "we're going to slam it to the locals." But we have seen in a decade this crisis just continue to expand and the public is demanding it.

But in addition to that, if one jurisdiction doesn't do something then it forces somebody else to do something and that's where we've been, and the housing production. So let's not lose sight of this. We can talk all day long about homelessness, but if you don't have a unit to put somebody to live in tiny, small, 3-D, whatever way it's built, then we are stuck.

We are absolutely stuck, because Judge Carter forced Orange County to say, "you cannot enforce on people camping outside or living outside unless you have a shelter bed." So in fact, some--everybody listen to that--some cities have built shelters and are doing more than their share. Some cities have done zero and that is affecting all of Orange County. But that is only the shelter part. It is not the permanent supportive. We have excellent agencies that are sitting here in the audience.

Orange County United, many others, Pathways for Hope, Salvation, many of the others who are doing working overtime. But we can't solve this. North Orange County cannot shelter all of Orange County's homeless. South Orange County, central Orange County and by the way Santa Ana has been doing far more than their share for many, many years. So when we talk about why don't we get the locals involved, many locals just say no, they absolutely say no. And they're not here because they know that they say no.

And then they get really angry when we say that they're saying no. Matter of fact, street medicine was just brought up as another solution for that. We won't have to have people go into emergency room and there's some cities who say we don't want anything to do with that. So when we absolutely won't entertain a solution and then we complain about an encampment or those people on the street, we're not solving a problem, we're complaining about a problem.

We're wanting transparency and audits and accountability, but we're not willing to do the work. Alright, with that, next.

Hello. This question is for Kelly Bruno-Nelson. My name is Marisol Johnson. I work at Dell McIntyre Center. I work with people with disabilities and seniors, and I myself have disabilities. I love that you gave so much money to build affordable apartments. My question is, are there any apartment complex that would be directly for people with disabilities or seniors? And also, I know that ADA has a percentage of how many units should be ADA accessible.

I was wondering if you guys have considered increasing that percentage just because, as we all know, we're all getting older. I know when I'm older, I want a unit. If I will have a house then that is accessible, because I never know what could happen. Also, we could all have an accident. We could all become disabled. So for me, it's very important to increase the accessible units in our community, especially Orange County.

I have worked with housing for a long time, and let me tell you, housing, finding an apartment is so hard. Finding an apartment that is accessible is like finding a diamond. It's so hard. So those are my questions.

Thank you.

I think those are great questions, and I have a couple of answers. One is: some of the funding that we did fund for permanent and affordable housing was specifically for seniors and for those that are disabled. So, yes, I agree with you. And those units need to be accessible. I also, though, want to mention that one of the CalAIM benefits is for modifications to homes. And every member that's a CalOptima Health member has a $7,500 benefit to make a house accessible.

So if you do have a disability and need grab bars or need a ramp, something like that, you're now eligible for $7,500 to make that home accessible. So it's not only building more homes, but we can also help to make the homes that exist meet your needs.

Thank you. Next. I think we have two more speakers and then we're going to close the Committee.

Thank you for having this, Assemblymember Sharon. My name is Mark Alipio. I'm the Executive Director of Ca Care Association, a direct provider led organization, a licensed residential care facility administrator for Elegant Care Villa. So we have a facility just down the street, a board member of the Long Beach Homeless Coalition and a representative of the Filipino American Chamber of Commerce. Our organization is a Ca Care Department, social services stakeholder advisory group for the licensed adult and residential care programs.

And I'm also the advisory group for the home and community-based programs with the California Department of Developmental Services. I'd like to add a public comment in emphasizing the importance in focusing in on an often undersubscribed licensed residential care facilities. These would be the gaps. I'd like to highlight my work in the home and community based programs and connect the Fairview Developmental Center's previous use. It was institutionalized-based services and often rendered to the people with developmental disabilities.

And so the state has shied away from focusing in on big institutions. Right? A solution that can work, we can start on focusing on the workforce, a community-based workforce that guarantees living wage, that reinforces skills training with educational program. But in order to do that, we need the resources from all levels of Administration to lean in. And how can we, as community-based programs, be part of that solution? Right?

It should be where we start a stakeholder where maybe people with lived experience could be a participatory of that, where that's where we can really establish the continuum of care. Right? And so how can we support you there?

Thank you. I appreciate your comments. There are many collaboratives, so if you don't know of some of the ones up in north, we can make sure you know those. But I do think, looking back at this new, if you want to call it, mental health reform, that the Governor just came down to Los Angeles to unveil. One of the pieces of that, that is somewhat controversial and we don't know how it's going to play out, but we do know it's moving forward.

And that is with the 30% of the Mental Health Services Act now being determined for permanent supportive housing. Now as a Legislator, that came to me and the Housing Committee very late on the very last night of session, and there were quite a few questions that not only the county had, but others have.

Although I'm a huge firm believer and we got to build more housing, what my concern of that is if we're going to pull out 30% for permanent supportive housing, but we don't have the buy in from the community and this is where we really get stuck. And I know that our CalOptima mentioned a project in Tustin, is how are we going to take 30% of the county's funding and then say, now we're going to distribute it in Orange County for more acute beds?

What kind of pushback are we going to get on that? Number one, how long is it going to take? Number two, because we know any housing project can take years. And is this going to be a smart move budget wise with the county funding because now you're pulling out 30%, and we didn't add another 30% into that budget. So we're going to take a budget That's already constrained and make it even smaller.

So there is, with the reimagining of mental health care, a visionary part of it, but there's also the reality of how much funding are you going to get? And if that 30% gets hung up, meaning you're not using year one, year two, year three, how long will you be able to keep that funding? And again, what are the communities that are going to say yes? And as we've heard, even with sober living, we hear the good actors, bad actors.

There's a lot of communities who just don't want them in their communities at all. So we still have a lot of work to do. And a lot of work to do is related to stigma, and it's related to myths versus facts, and it's related to those people and us. And until we can really have a public conversation about that, we will continue to have those delays and this longevity issue of not being able to put up these beds as quickly as we need.

Last comment for today.

Well said. I've helped a lot of people look into permanent supporting, supportive housing. And a big obstacle that I found when I'm trying to help them out with pave work, my background is in financial services, is not having credit history, not having birth certificates, not having Social Security cards. And then I'm asking them, why don't you have these? Did your navigator let you know that this had to be taken care of? They say, "no."

It was kind of explained to me, but I didn't quite get it. So my question is, is there a way to backspace a little bit at these housing complexes where they're applying for, they've got their voucher. It's like you said, the stigma. They look at these vouchers and I'm wondering if there's a way to incentivize people that have hotels and have apartment complexes and maybe a liaison with these people. So there isn't that stigma. It's a program that works.

This is the first time I've heard about a deposit being paid in a first month, and you said this earlier. It's important for the navigation centers to also know this because last I spoke to one of them, which was a month ago, that did not come up when I asked. So That's all. Thank you.

Thank you. And That's a really great way to end this. And again, we do a lot. But our next step, and more effective step, is to make sure not only the providers, but the navigators and the individuals themselves know what they have available. I'm really proud that I wrote a Bill in 2012 that allows people to get either an ID or a birth certificate from the DMV, and it be paid for.

So if you don't know that, you can work with your nonprofit to help with that. There was another Bill close to that written this year, as far as many bills related to navigators. But again, we got to go back to the training. Does everybody have the most updated information? And laws change all the time. So even related to taking the vouchers, we are writing new laws all the time. One of them was to say that a rental person cannot ask about a voucher.

So we're trying to encourage that. Again, I mentioned OC United. I know they're working with landlords to try to accept these vouchers, but that is one of the most difficult things. If somebody actually attains a voucher, which we know can take five to 10 years, and then they can't find a place to use it, it's like the gold ticket that you can't use. So we will continue working on that space. Again, I want to thank the providers, the people who work in this space every day.

We just talk. You guys are out there in the field. We really thank you because we know this is some of the hardest work possible to do, to take somebody who's unhoused, navigate with them and get them through so many obstacles. And you really are doing God's work. You really are. And we thank you. Let's give everybody a cheer. Stand up. If you are a provider or you work in this place, please stand up. Please stand up.

Thank you, ladies and gentlemen, these are the people who are working on the front line, and we owe you a huge debt and we thank you sincerely. I want to thank everybody again for attending, and we appreciate you. Please keep in contact with us. Thank you so much. Bye.