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From YouTube: Committee on Public Health and Human Services 3-12-2018
Description
The Committee on Public Health and Human Services of the Council of the City of Philadelphia held a Public Hearing on Monday, March 12, 2018to hear testimony on the following item:
180037 Resolution authorizing the Committee on Public Health and Human Services to hold hearings to assess the City of Philadelphia's efforts, as coordinated by the Managing Director's office and our Human services departments, to prevent and treat abuse, addiction, and disease related to the use of opioids.
Committee on Public Health and Human Services
Chair: Councilwoman Cindy Bass (8th District)
Vice Chair: Councilwoman Maria D. Quiñones-Sánchez (7th District)
A
Human
Services,
the
purpose
of
this
meeting
is
to
hear
testimony
on
resolution
number
one:
eight:
zero,
zero.
Three
seven
members
of
the
committee
in
attendance,
our
councilman
bill,
Greenlee,
Councilwoman,
Maria,
Kenyon,
Sanchez
and
I-
wanted
to
ask
council
woman
Sanchez
for
opening
remarks.
As
a
sponsor
of
the
resolution.
B
Thank
them.
Thank
you,
madam
chair
I
will
be
brief,
as
I
expect
most
of
our
speakers
to
be
quite
elegant,
eloquent
in
their
presentations
around
what
has
been,
in
many
cases,
tremendous
work
and
stride
by
folks
to
grapple
with
what
everybody,
both
the
president
and
the
governor
has
identified
as
America's
crisis.
I
particularly
want
to
thank
the
stakeholders
in
the
community
folks
who've
been
on
the
ground
and
have
done
everything
they
can
to
be
as
supportive
as
they
possibly
can.
B
Why
the
resolution
and
why,
this
time
I
think
it's
hugely
important,
that
those
of
us
in
policy
positions
and
the
community
understand
what
in
fact
the
city
is
doing,
there's
millions,
if
not
billions,
of
dollars
invested
in
the
opioid
situation
in
the
city,
we've
seen
additional
resources
added
and
commitments
by
the
governor
and
the
president
I
think.
It's
only
fitting
that
at
this
particular
time
we
have
a
public
discussion.
Let
me
emphasize
that
a
public
discussion
about
where
your
money
is
going.
B
So
that
we
can
meet
people
where
they
are
and
help
them
through
this
lifetime
situation
and
at
the
same
time
manage
the
quality
of
life
and
its
impact
and
minimizing
the
impact
it
has
on
residents
and
neighbors
I.
Think
that
in
all
of
my
years
in
community
development,
work
and
I've
been
at
this
for
a
minute
30
plus
years
never
have
I.
B
Seen
such
a
complicated
layered
situation
as
I
see
in
the
community,
I
will
be
unapologetic
in
my
defense
for
everyone
in
my
district,
but
in
particularly
the
young
people
who
now
have
we
have
almost
normalized.
What
is
not
normal,
those
of
us
as
we
sit
back
and
we
theorize
about
what
we
should
be
doing,
really
need
to
pay
more
attention
and
I
have
a
graphic
that
I
will
be
putting
up
it's
a
photo
Andre.
If
you
could
put
that
up.
B
This
was
set
to
me
recently
through
Instagram
by
one
of
the
shutterbug
shutterbug
is
a
small
group
of
photographers
out
of
Stetson.
It's
a
group
that
we
sponsor
and
it's
an
Instagram
that
he
that
he
has
and
Javier
explains
it
the
best
he
takes
a
picture
of
trash
and
he
talks
about
what
happens
underneath
those
tracks
every
day
the
people
that
he
wants
to
be
sympathetic
to,
but
at
the
same
time
feels
extremely
distraught
at
the
fact
that
he
can't
walk
through
there
and
that
at
night,
unseemly
things
happen
there.
B
It
is
because
of
Javier
and
others
that
we
have
to
be
focused
intentional
and
much
quicker.
At
addressing
this
situation,
the
the
residents
of
Quezon
10:00
in
the
area
that
both
councilman,
Scola
and
I
represent
have
been
patient.
They've
rolled
up
their
sleeves
they've
clean
streets
with
us
they've
done
everything
that
they
can
and
yet
they're
still
at
visalia,
basta
ya.
There
is
only
but
so
much
you
can
take.
B
It
is
sad
when
I
sit
and
talk
to
the
seniors
who
live
at
Somerset
villas,
who
tell
me
Maria,
I,
can't
even
walk
over
to
Quezon
ten
to
do
my
daily
shoppings
there's
a
hundred
of
plus
seniors
who
are
trapped
in
their
apartment,
complex
over
on
Somerset
villas.
This
is
not
a
creation
of
one
there's.
Definitely
enough
blame
to
go
around.
B
So
I
want
to
thank
all
of
you
from
the
beginning.
I
want
us
to
be
respectful
in
our
disagreements,
respectful
in
our
passion,
there's
no
more
more
passionate
than
this
fears.
Nothing
not
in
front
of
you,
but
let
me
tell
you
that
never
have
I
felt
more
committed
and
and
more
optimistic,
because
I
do
know
that
the
stakeholders
on
the
ground
who've
been
doing
this
are
just
as
committed
to
do
this
and
well
I
want
to
do
here
is
figure
out
how
government
helps
and
how
government
stays
out
of
the
way.
A
C
Name
is
eva
Gladstein,
I'm
deputy
managing
director
for
health
and
human
services
for
the
city
of
philadelphia
good
morning,
Councilwoman
bass
and
other
members
of
the
committee.
Thank
you
for
the
opportunity
to
testify
today
regarding
resolution
number
one:
eight:
zero,
zero
three
seven
to
assess
the
city's
efforts
to
prevent
entry's
abuse,
addiction
and
disease
related
to
the
use
of
opioids.
C
Our
cabinet
of
Health
and
Human
Services
consists
of
five
agencies
that
collectively
work
to
ensure
that
our
city's
most
vulnerable
citizens
are
healthy,
safe
and
supported.
They
are
the
department
of
behavioral
health
and
intellectual
disability
services,
the
office
of
community
empowerment
and
opportunity,
the
office
of
homeless
services,
the
Department
of
Public
Health
and
the
Department
of
Human
Services
I'm
joined
today
by
three
of
those
agencies:
behavioral
health
and
intellectual
disability
services,
health
services
and
public
health.
C
C
We
anticipate
when
the
numbers
are
finalized
four
times,
as
many
people
will
have
died
of
drug
overdoses
in
2017
as
compared
to
the
number
who
were
victims
of
homicide.
Roughly
1200
people
will
died
of
overdoses
during
2017.
This
is
as
compared
to
nine
hundred
and
seven
people
in
2016
and
seven
hundred
and
one
people
in
2015.
We
know
that
about
80%
of
these
deaths
involved
opioids
recognizing
the
scope
of
this
public
health
crisis.
The
mayor
created
the
mayor's
task
force
to
combat
the
opioid
cry
in
early
2017
a
little
bit
over
a
year
ago.
C
Its
charge
was
to
develop
a
comprehensive
and
coordinated
plan
to
reduce
opioid
abuse,
dependence
and
overdose.
It
had
a
very
robust
civic
engagement
process.
It
hosted
listening
sessions
across
the
city
to
gather
input
from
residents.
In
addition,
over
200
people
actually
participated
either.
As
a
member
of
the
task
force
or
one
of
its
four
working
committees,
all
of
the
meetings
were
open
to
the
public
and
they
were
very
well
attended.
We
were
pleased
at
councilman.
Oh
was
able
to
participate
as
a
representative
of
City
Council
in
that
task
force.
C
It
completed
its
work
in
April
and
we
presented
the
final
report
to
Mayor
Kenney
on
May
19th.
The
report
and
I
just
have
one
copy
here,
but
we'll
be
happy
to
make
available
if
members
of
council
not
yet
seen,
it
includes
18
recommendations
there
in
the
areas
of
prevention
and
education,
treatment,
overdose
prevention
and
the
involvement
of
the
criminal
justice
system.
We've
been
working
diligently
to
implement
those
recommendations.
Our
progress
is
reported
in
quarterly
public
meetings
hosted
by
the
mayor's
executive
commission
on
drugs
and
alcohol.
C
Again,
those
reports
are
posted
publicly
they're
available
in
those
meetings
are
welcome
and
open
to
the
public.
We
work
as
a
cabinet
meeting
regularly
in
integrating
our
services
to
increase
our
effectiveness.
The
Department
of
Public
Health
has
taken
the
lead
on
prevention
and
education,
working
with
insurers,
health
systems
and
doctors
to
slow
down
the
momentum
of
the
epidemic.
They've
also
focused
on
harm
reduction,
specifically
the
distribution
of
naloxone
or,
as
it's
known,
narcan,
which
is
the
overdose
antidote.
C
Behavioral
health
has
been
working
diligently
on
expanding
its
treatment,
continuum,
engaging
people
and
helping
them
get
into
treatment.
I
want
to
spend
a
minute
here
talking
about
our
unique
opportunity
that
we
have
as
a
city
of
Philadelphia
regarding
behavioral
health
services,
for
people
who
are
eligible
for
Medicaid
one
of
DBH
is
components,
is
community
behavioral
health,
which
we
called
cbh.
It's
a
nonprofit
organization
that
was
established
over
20
years
ago,
and
it
is
a
Medicaid
managed
care
organization
for
behavioral
health
services.
C
It
operates
much
the
same
way
as
managed
care
plans
to
which
we
all
get
our
health
coverage.
The
city
receives
an
annual
capitation
from
the
state,
which
is
an
amount
of
money
that
we
can
pay
for
a
service
for
each
member
covered
by
the
plan.
These
are
state
and
federal
Medicaid
dollars
and
are
highly
regulated
by
both
federal
and
state
rules.
C
Cbh
is
responsible
for
paying
providers
for
care.
It's
members
need,
according
to
those
rules,
like
other
managed
care
plans,
cbh
credentials
of
providers
who
participate
in
the
network,
negotiates
rates
with
those
providers
and
manages
the
care
of
eligible
members,
because
cbh
is
a
nonprofit
organization,
it
does
not
take
a
profit.
Its
administrative
costs
are
7
percent
and
they're
among
the
lowest
of
medicaid
behavioral
health
MCS
in
the
state.
As
a
result,
CB
H
is
one
of
the
most
well
developed
Continuum's
of
treatment
services
available
to
Medicaid
members.
C
We're
proud
of
this
publicly
governed
nonprofit
managed
care
entity
which
is
an
alternative
to
the
standalone.
For-Profit
managed
care
companies
that
manage
behavioral
health
care
from
Medicaid
beneficiaries
in
other
parts
of
the
state.
Our
plans,
especially
in
an
asset
in
times
like
this,
when
the
epidemic
requires
close
integration
with
other
aspects
of
this
city's
social
services
and
health
under
the
Kenny
administration,
we've
continued
to
build
on
the
strong
history
and
to
strengthen
integration
with
other
cabinet
agencies
and
key
partners
in
the
city.
C
For
example,
last
year
we
expanded
see
BHS
board
of
directors
to
include
commissioners
Farley
and
director
Liz
Hirsch
of
the
office
of
homeless
services,
as
well
as
adding
the
superintendent
of
the
school
district,
dr.
William
height
and
care,
Bradford
gray
who's,
a
chief
defender,
the
defenders
Association
of
Philadelphia,
and
our
testimony
today,
Commissioner
Farley
will
provide
more
detail
on
the
prevention,
education
and
harm
reduction
measures
we
are
taking
to
address
the
opioid
epidemic.
C
Commissioner
Jones
will
describe
the
continuum
of
available
treatment
options,
innovative
programs
to
encourage
people
with
substance,
use
disorder
to
enter
treatment
and
provide
more
detail
on
how
cbh
ensures
the
quality
of
providers
and
consumer
satisfaction
as
well.
Finally,
Liz
Hirsch
director
of
the
office
of
homeless
services
will
provide
information
and
how
we
addressing
some
of
the
community
impacts
of
the
opioid
crisis.
She
will
share
information
on
low
barrier,
housing
options
and
new
models
that
are
working
to
provide
housing
stability
and
enabling
people
to
choose
to
enter
treatment.
C
We
want
to
receive
their
input
and
make
adjustments
to
the
plan
based
upon
their
feedback
once
that
we
have
finished
that
process
which
should
take
be
completed
within
the
next
week
or
two
we'll
share
it
more
broadly
with
the
general
public
and
certainly
with
council
offices.
With
brief
council
offices
aren't
the
preliminary
plan,
but
we
don't
want
to
put
it
out
there
publicly
until
we've
been
able
to
work
with
this
local
civic
associations.
I
wanted
to
close
by
sharing
that
the
mayor's
budget
proposal
includes
additional
resources
to
address
the
opioid
crisis.
C
It
includes
funding
for
an
additional
140
units
of
low
barrier
housing
focused
on
the
Kensington
community.
Liz
Hershel
will
be
speaking
more
about
that
a
police
assisted
diversion
program
for
low-level
crimes
in
the
East
Division.
That
will
enable
us
to
move
people
to
services
resources
to
continue
to
train
doctors
on
the
evidence
base,
medication-assisted
treatment,
additional
supplies
of
narcan
and
an
alternative
EMS
response
unit
that
the
fire
department
will
operate.
That
will
help
connect
people
to
treatment
and,
finally,
resources
to
develop
a
litter
cleanup
program
in
Kensington.
C
These
additional
efforts
will
help
us
continue
to
work
towards
turning
the
tide
on
this
epidemic,
improving
the
lives
of
Philadelphians,
who
have
been
impacted
by
the
crisis.
My
written
testimony
fails
to
mention
that
the
amount
that's
in
the
five-year
plan
is
about
twenty
million
dollars
for
these
new
services.
No
new
me
sources.
Thank
you
again
for
the
opportunity
to
testify
and
I'll
be
available
to
answer
questions.
C
A
F
Great
good
morning,
council
of
abassin
members
of
the
committee
I'm
dr.
Thomas
Farley
Commissioner,
for
the
Department
of
Public
Health.
The
opioid
problem
is
perhaps
the
greatest
public
health
crisis,
this
city,
as
Fae,
face
in
the
last
century.
His
deputy
managing
director
Gladstein
said
when
we
have
finished
compiling
our
data
for
2017.
We
expect
have
counted
more
than
1,200
people
in
Philadelphia
dying
of
drug
overdose,
with
more
than
80
percent
of
those
overdoses
involving
opioids,
including
prescription,
opioids,
heroin
and
fentanyl.
Those
overdose
deaths
have
hit
every
demographic
group
in
every
corner
of
Philadelphia.
F
For
example,
in
the
first
nine
months
of
2017
alone,
we
saw
569
overdose
deaths
in
Caucasians,
248
overdose
deaths
in
african-americans
and
126
overdose
deaths
in
Hispanics
in
every
race
and
ethnic
group.
The
number
of
deaths
from
drug
overdose
was
far
higher
than
the
number
of
deaths
from
homicide.
F
Every
neighborhood
in
the
city
is
hit
hard
of
the
overdose
deaths
that
have
we
mapped
so
far.
In
2017,
Council
District
eight
has
seen
66
overdose
deaths.
District
five
has
seen
95
deaths.
District
six
has
seen
122
deaths
in
District.
Seven
has
seen
287
deaths,
no
Council
District
will
have
had
few
and
40
people
who
died
of
drug
overdose
in
2017.
F
Even
this
number
of
overdose
deaths
represents
just
a
tip
of
a
huge
iceberg
of
opioid
use
and
addiction.
We
estimate
that
they're
between
50,000
and
70,000
persons
in
Philadelphia
are
currently
using
heroin.
168
thousand
people
are
one
in
seven,
adults
are
currently
taking
prescription
opioids
and
nearly
500,000,
or
one
in
three
adults
received
a
prescription
for
opioids
in
the
previous
12
months.
This
crisis
is
fed
by
three
problems.
First,
doctors
and
other
health
care
providers
strongly
encouraged
by
drug
companies
are
prescribing
far
too
many
opioids,
causing
many
people
to
get
addicted,
who
otherwise
would
not?
F
Second,
according
to
DEA
data,
Philadelphia
has
the
purest
and
cheapest
heroin
of
all
big
cities
in
the
nation.
Third
street
corner
drug
dealers
are
now
distributing
fentanyl
a
highly
potent
synthetic
opioid
that
is
particularly
addictive
and
deadly.
The
crisis
has
many
manifestations
and
touches
nearly
everyone
directly
or
indirectly.
It
has
greatly
increased
the
number
of
people
who
are
addicted
and
needs
substance
use
treatment.
It
has
increased.
The
number
of
workers
have
difficulty
functioning
because
they're
under
the
influence
of
drugs,
it
has
increased
the
spread
of
hepatitis
C
from
people
sharing
syringes.
F
It
has
put
strains
on
Hospital
emergency
departments
and
EMS
crews
dealing
with
non
fatal
overdoses.
It
has
led
to
large
increases
in
babies
born
addicted
to
opioids,
which
will
further
stress
the
child
welfare
system.
It
led
to
increases
in
people
who
are
living
on
the
streets
of
Philadelphia
and
fed
the
homicide
problem
from
drug
dealers
fighting
over
turf.
There
is
no
single
solution
to
this
crisis.
Addressing
the
problem
requires
many
actions
by
many
organizations.
F
The
Philadelphia
Department
of
Public
Health
is
one
of
the
city
agencies,
implementing
the
18
recommendations
of
the
mayor's
Task
Force
on
opioids
to
prevent
people
from
becoming
addicted.
We
are
working
to
get
medical
professionals
to
reduce
their
prescribing
of
opioids.
Our
work
includes
mailing
treatment
guidelines
to
16,000
physicians
in
the
Greater
Philadelphia
area,
mailing
dashboards
to
more
than
2600
prescribers.
That
show
how
they're
prescribing
compares
to
their
peers,
having
staff
visit
over
1300
prescribers
in
their
offices
to
deliver
clear
recommendations
on
prescribing,
less
and
working
with
every
health
care
system.
F
In
and
every
health
insurer
in
Pennsylvania
to
discourage
opioid
prescribing
by
their
healthcare
providers
paired
with
this
work,
we
have
run
mass
media
campaigns
directed
to
consumers.
Don't
take
the
risk
warning
about
the
risks
of
opioids.
Even
if
a
doctor
prescribes
these
drugs
for
people
who
are
dependent
on
opioids,
we
are
working
with
the
department
of
behavioral
health
and
intellectual
disability
services
to
expand
medication,
assisted
treatment
by
physicians.
The
specialized
substance
use
treatment
system
will
need
to
be
supplemented
by
m80
offered
in
medical
practices.
If
we
are
to
reach
everyone
who
needs
treatment.
F
My
department
is
also
working
with
the
department
of
behavioral
health
and
intellectual
disability
services
on
overdose
prevention
and
harm
reduction.
We
provide
funding
to
prevention
point
for
their
work,
to
prevent
HIV
and
prevent
overdoses.
We
distribute
the
opioid
antidote
naloxone
to
many
different
organizations
that
either
use
it
to
revive
people
or
give
it
to
drug
users
and
people
in
contact
with
them.
This
fiscal
year
we
have
already
distributed
over
28,000
doses
of
naloxone,
and
this
week
we
are
launching
a
media
campaign
encouraging
everyone
to
carry
naloxone
available.
To
answer
any
of
your
questions.
G
T
Jones
again
good
morning,
chairwoman,
Cindi
bass,
vice
chairwoman,
Maria
can
use
any
as
members
of
the
Committee
on
Public,
Health
and
Human
Services
again,
I
am
David
T
Jones
Commissioner
of
the
Department
of
Behavioral
Health
and
intellectual
disability
services.
Thank
you
for
the
opportunity
to
testify.
In
response
a
resolution
number
one:
eight:
zero,
zero.
Three
seven
DBH
ids
is
responsible
for
oversight
of
our
provider
network
that
serves
children,
youth,
adults
and
families
in
philadelphia
with
behavioral
health
challenges
and
our
intellectual
disabilities.
G
Today's
testimony
will
focus
on
the
following
three
areas:
DBH
IDS's
response
to
the
opioid
epidemic,
the
treatment
continuum,
with
the
focus
on
substance,
use
disorder
and
access
points,
quality,
oversight
of
the
DBH
IDs
provider
network.
Much
of
this
work
has
centered
at
community
behavioral
health,
which,
as
Eva
described,
is
a
city
governed.
Nonprofit
managed
care
entity
that
delivers
behavioral
health
for
Medicaid
eligible
individuals.
Dbh
also
manages
services
for
individuals
who
are
on
short.
Our
work
touches
many
lives.
Both
national
and
Philadelphia
data
indicates
that
one
in
five
people
experience
some
form
of
mental
illness.
G
And/Or
substance
use
disorder
in
calendar
year,
2016
community
behavioral
have
had
nearly
700,000
members
enrolled
and
Medicaid.
Nearly
half
of
all
philadelphians
of
those
who
were
enrolled
in
Medicaid
or
uninsured
170,000
were
directly
served
by
DB
SIDS,
which
is
24%
of
those
enrolled.
This
is
consistent
with
national
rates
of
behavioral
health
services
utilization
regarding
the
opioid
epidemic,
you've
heard
already
from
others
about
the
unprecedented
magnitude
of
the
crisis.
G
I
would
just
underscore
that
and
say
that
ensuring
that
individuals
who
have
opioid
use
disorder
having
access
to
treatment
is
among
my
highest
priority
as
commissioner,
as
well
as
for
the
department
as
a
whole.
We
are
making
progress
in
calendar
year,
2016
more
than
26,000
individuals
participated
in
substance,
use,
disorder,
treatment
services
and
about
14,000
of
whom
were
retreated
for
opioid
use
disorder.
G
To
give
you
a
sense
of
the
size
of
our
network
cbh
contracts
with
over
a
hundred
and
seventy
five
separate
clinical
programs
and
service
locations,
and
if
you
look
at
a
department
more
widely,
it's
over
200
providers.
These
contracted
entities
comprise
over
2000
beds,
including
inpatient
hospitalization
programs,
residential
programs
for
rehabilitation
and
detoxification
and
halfway
houses.
G
In
addition
to
the
bed
based
services,
cbh
also
offices,
member
services
of
varying
levels
of
intensity
within
ambulatory
and
community-based
settings,
these
services
include
outpatient
and
inpatient
in
intensive
outpatient
programs,
partial
hospitalization
and
services
designed
to
keep
recipients
and
community
settings
such
as
case
management
and
peer
specialist
services.
Our
efforts
to
address
epidemic,
the
epidemic
are
centered
around
making
sure
treatment
is
accessible
and
removing
any
barriers
that
keep
it
from
being
so
and
making
sure
treatment
is
highly
of
high
quality
and
effective.
G
I
will
talk
in
a
moment
about
our
general
quality
efforts,
but
in
the
area
of
opioid
use
disorder
as
you've
heard,
the
most
effective
treatment
is
medication,
assisted
treatment.
M80
is
a
use
of
medications
such
as
methadone,
buprenorphine
or
vivitrol.
In
combination
with
counseling
and
behavioral
therapies,
research
has
demonstrated
that
m80
is
twice
as
effective
as
other
types
of
treatment
for
opioid
use
disorder.
So
much
of
our
work
is
focused
on
increasing
the
availability
and
use
of
m80
in
Philadelphia
at
all
levels
of
care.
G
Some
of
our
work
to
increase
access
involves,
bringing
resources
to
where
folks
are,
for
example,
through
our
coordinated
response
by
facilitating
addiction
treatment.
We've
increased
a
number
of
days
a
week.
We
are
offering
on-site
assessment
at
prevention
point
Philadelphia,
as
well
as
providing
a
mobile
medical
vehicle
to
take
services
to
individuals
and
needs
of
treatment.
G
We
also
have
added
funds
to
a
program
that
helps
individuals
to
obtain
identification
cards
for
treatment
services
in
coordination
with
our
community
partners
that
include
again
prevention,
point
project
home
and
one
day
at
a
time,
we've
expanded
outreach
efforts
to
engage
individuals
and
connect
them
to
services,
supports
and
treatments
in
the
Kensington
Farrell
area.
We've
begun
a
warm
handoff
program
at
Temple,
Episcopal
emergency
room
in
crisis
response
center,
so
that
individuals
who
present
after
overdose
or
for
other
health
needs
can
be
connected
to
treatment.
G
The
program
which
uses
certified
recovery
specialists
served
125
individuals
in
the
month
of
January,
resulting
in
78,
coordinated
referrals
to
treatment,
while
thanks
to
Medicaid
expansion,
many
more
individuals
are
eligible
for
cbh
services.
There
are
some
individuals
who
are
not
insured
and
we've
streamlined
our
access
to
same-day
services.
For
those
who
are
uninsured,
we
also
are
increasing
access
by
scaling
up
treatment
providers.
Capacity,
for
example,
we've
added
a
partial
hospitalization
program
and
we
begin
expanding
medication,
assisted
treatment
at
Kensington,
from
160
to
300
slots
to
serve
individuals
with
substance
use
or
significant
corcoran
challenges.
G
We're
working
to
embed
withdraw
management,
including
medication,
assisted
treatment
to
help
manage
withdrawal
management
symptoms
across
all
levels
of
care,
working
towards
the
goal
of
having
all
providers
offer
the
service
withdrawal
management
is
currently
being
offered
in
a
community
through
several
providers,
including
PMC
pathways
of
recovery,
Northwest,
Human,
Services
and
wedge
recovery.
Centers.
G
Recognising
the
importance
of
stable
housing
to
recovery,
we've
expanded
a
use
of
17
DBH,
funded
recovery
houses
from
three
hundreds
of
333
beds
and
added
a
seventh
site
to
our
journey
of
hope,
housing
program
which
increased
capacity
to
128
beds,
we've
also
extended
hours
of
some
residential
programs
to
take
individuals
after
5:00
p.m.
and
during
the
weekends.
G
We
are
also
supporting
eight
newly
funded
substance
use
disorder,
early
intervention
programs
to
provide
individual
group
and
family
therapy
at
the
same
time
we're
working
in
concert
with
the
health
department
and
other
city
and
community
partners
to
reduce
fatal
overdoses
and
saves
lives.
Last
year,
DBH
IDs
narcan
training
series
trained
more
than
700
individuals
to
administer
narcan
and
distributed
265
narcan
kits
to
individuals
trained
this
year.
We
hope
to
train
an
additional
700
individuals.
Our
trainings
are
open
to
all
city
department,
employees,
peers,
family
members,
provider
agency
stakeholders
and
the
public.
G
We
also
plan
to
distribute
more
than
16,000
doses
of
naloxone
to
partners
this
year.
Now
we'll
talk
about
how
we
ensure
that
individuals
that
our
services
that
are
high-quality
and
providers
are
following
the
state
and
federal
rules
that
apply
to
Medicaid.
Like
any
managed
care
plan,
CV
AIDS
has
an
extensive
structure
in
place
to
monitor
providers,
adherence
to
programmatic
and
contractual
obligations.
The
network,
improvement
and
accountability.
Collaborative
division
at
DBS
is
responsible
for
monitoring
and
reviewing
all
providers.
G
Additionally,
there
is
a
compliance
division
which
assists
in
facilitating
adherence
to
applicable,
federal
and
state
regulations
governing
the
Medicaid
program,
as
well
as
cbh
policies
and
procedures.
Finally,
the
consumer
satisfaction
team,
which
was
created
in
1990,
was
the
first
organization
of
its
kind
in
the
country
staffed
entirely
by
recipients
of
behavioral
health
services
and
family
members.
G
Cst
goal
is
to
ascertain
whether
members
and
their
family
members
are
satisfied
with
the
services
we
have
provided
an
overview
of
the
department's
response
to
the
opioid
epidemic,
provided
information
about
accessing
treatment,
in
particular
for
substance,
use
disorder
and
shared
components
of
our
oversight
process.
I'm
appreciative
for
the
opportunity
to
testify
today.
If
you
have
questions,
I
will
answer
them
now.
H
Morning,
Councilwoman
bass
and
other
members
of
the
committee,
my
name
is
Liz
Hersh
and
I'm,
the
director
of
the
city's
office
of
homeless
services.
Thank
you
for
the
opportunity
to
testify
today
using
the
Kensington
count
plans
as
the
basis
the
office
of
homeless
services
established
a
23
bed
respite
with
prevention
point
last
winter,
based
on
its
high
utilization.
We
then
expanded
it
to
40
beds
this
winter.
In
its
first
year
of
operation
prevention,
points,
respite
served,
160
people
of
whom
40%
entered
treatment
or
got
permanent
housing.
This
is
a
tremendous
success.
H
Our
method
has
been
to
listen
to
the
people
on
the
ground
closest
to
the
problem
and
support
their
efforts
in
addressing
it
to
the
best
of
our
ability.
Similarly,
we
added
15
dedicated
beds
to
the
60
already
being
provided
by
pathways
to
housing,
the
first-in-the-nation
Street
to
home
program
for
people
with
opioid
use
disorder.
H
Despite
this,
expansion
of
investments,
the
growth
of
homeless,
encampments
by
the
opioid
given
by
the
opioid
crisis
is
plaguing
kensington.
It's
a
humanitarian
crisis
that
presents
a
health
and
safety
threat
not
only
to
the
people
living
there,
but
to
the
neighbors
who
live
nearby.
We
must
acknowledge
this
reality
on
January
and
our
point.
In
time
count
we
found
that
the
number
of
people
experiencing
street
homelessness
in
Kensington
and
that's
defined
as
zip
codes,
one
nine
one,
three
three,
two
five
and
three
four
had
actually
gone
down
from
227
to
210.
H
Yeah
Kensington
has
the
second
highest
concentration
of
homeless
people
in
the
city
after
Center
City,
the
homeless,
encampments
in
the
Kensington
area,
specifically
under
the
tunnels
north
of
Lehigh
Avenue
on
tulip,
Kensington,
Frankfort
and
emerald
streets
have
an
estimated
population
of
200
people
in
encampments.
Our
national
and
growing
problem.
The
National
Center
on
homelessness
and
poverty
found
a
thirteen
hundred
and
forty
two
percent
increase.
H
Thirteen
hundred
and
forty
two
percent
increase
in
the
number
of
homeless,
encampments
from
nineteen
and
2007
to
a
high
of
two
hundred
and
seventy
four
in
2016
the
last
full
year
of
data.
It's
a
national
crisis
and
yet
the
new
budget
proposed
by
the
White
House
slashes
all
forms
of
evidence-based
housing
assistance,
leaving
communities
like
Philadelphia
on
our
own
working
in
a
coordinated
effort
with
partners
throughout
the
city.
H
We
have
taken
a
number
of
steps
to
manage
this
dire
situation
so
far
and
I
want
to
acknowledge
again
that
we
are
also
frustrated
and
know
that
it's
not
enough
under
the
leadership
of
the
Eastern
Division
Police
Inspector
Ray
Convery,
we
established
a
homeless
detail,
a
small
group
of
officers
dedicated
entirely
to
the
homeless
encampment.
This
is
based
on
the
model
in
Center.
City
replicates
that
successful
model.
H
They
do
a
nightly
count
of
people
sleeping
weekly
cleanups
and
have
a
constant
presence
in
the
community,
deploying
the
combines,
push
and
pull
of
the
police
officers
and
the
homeless
outreach
teams.
The
people
in
the
encampments
were
asked
to
move
to
one
side
of
each
street
to
allow
the
neighbors
safe
passage.
This
arrangement
was
the
suggestion
of
the
Somerset
neighbors
for
better
living
to
enable
neighbors
to
walk
through
the
tunnels
without
going
into
the
street.
While
it
is
progress
that
is
far
from
the
resolution
needed.
H
The
streets
department
has
increased
to
twice
weekly
trash
pickups
and
encampment
residents
have
been
provided
with
trash
containment
supplies
at
the
neighbors
requests.
L&Amp;I
has
also
inspected
all
the
local
scrap,
metal
collectors
and
one
has
closed
down.
Scrap
metal
is
a
source
of
income,
often
used
for
drug
purchase.
That
leads
to
petty
theft
in
the
neighbourhood
and
has
been
a
cause
of
considerable
concern.
H
The
office
of
community
engagement
under
the
direction
of
Johanna
Otero
Cruz
in
coordination
with
the
police
has
distributed
kits
to
neighbors
that
include
sharps
containers,
grabbers
no
trespassing
signs
and
blue
lightbulbs
to
empower
residents
to
take
back
their
streets
by
containing
and
minimizing
the
harm
of
needles
on
the
street
and
discouraging
intravenous
drug
use
in
front
of
houses.
This
also
enables
the
police
to
enforce
no
trespassing
laws.
In
addition,
our
office
is
aggressively
pursuing
an
additional
80
RESP
BET's.
H
A
respite
is
a
40
about
a
40
bed,
small
low
barrier
place
in
the
community
for
people
experiencing
homelessness,
and,
in
this
case,
specifically
opioid
use
disorder
to
come
in
and
be
cared
for.
They
can
enter
without
ID
and
drug
testing
is
not
required,
although
they
are
not
allowed
to
bring
in
their
works
or
to
bring
in
weapons.
This
model
is
based
loosely
on
the
safe
haven
pioneered
in
the
1990s
by
project
home
and
supported
by
DBH
IDs.
H
The
respite
uses
a
housing
first
model,
while
many
of
us
wish
that
those
in
the
encampments
would
seek
treatment
first,
experiencing
experience
is
showing
us
that
sometimes
providing
housing
first
is
a
better
option.
We
have
found
that
when
people
have
a
place
to
come
in
to
get
warm
or
cool
fed
medical
care
feel
safe
and
comfortable,
then
they
can
start
to
make
plans
and
think
about
their
future.
Based
on
the
success
of
this
model,
we
have
aggressively
pursued
a
second
respite
in
the
neighborhood.
H
It's
taken
several
months
to
identify
a
site,
as
the
community
is
divided,
some
believe
that
Kensington
is
already
a
magnet
and
that
any
new
respite
should
be
cited
elsewhere,
while
others
are
clamoring
for
more
beds.
We
analyzed
the
number
of
homeless
facilities
in
the
neighborhood
and
found
that
it
is
actually
quite
underserved.
H
There
is
one
shelter
and
that's
the
one
we
established
last
year
today.
We
are
replete
report
that
impact
services
in
the
final
stages
of
negotiating
a
lease
to
provide
40,
more
respite
beds,
operated
by
prevention.
Point
and
again,
as
I
mentioned,
our
goal
is
to
add
60
more
housing
first
units
next
year,
I'd
like
to
talk
a
little
bit
specifically
about
encampments,
because
this
is
a
new
problem
and
encampments
need
a
new
strategy.
The
office
of
homeless
services
has
researched
other
cities
to
try
to
better
understand
how
better
to
address
the
problem.
H
San
Francisco
is
the
model
that
looks
most
promising.
They
have
over
a
thousand
tents
on
the
streets
of
San
Francisco.
They
have
deployed
what
they
call
an
encampment
resolution
team.
It's
a
multidisciplinary
team
that
engages
and
then
helps
resolve
the
homelessness
of
the
residents
they
use.
What
I
will
simplistically
refer
to
as
a
carrot
and
stick
approach.
They
first
develop
a
bi
name
list
of
people
in
the
encampment
and
assess
what
they
need
and
they
do
this
systematically.
H
They
go
so
far
in
some
cases
as
to
begin
medication,
assisted
treatment
on
the
street
and
have
found
that,
with
medications
like
suboxone,
that
some
people
are
able
to
think
more
clearly
about
their
lives
and
make
better
choices
and,
as
David
Jones
already
said,
there's
mobile
services
and
that
would
be
able
to
deploy
a
range
of
these
mobile
teams
that
would
be
able
to
rip
deploy
a
range
of
these
services.
The
navigation
Center
offers
a
range
of
services
with
easy
access.
H
It
also
offers
beds
for
people
finding,
as
we
have
that
a
good
night's
sleep,
meals,
safety,
stability
and
care
enables
better
problem-solving
and
in
the
final
stages
of
the
encampment
resolution
team.
What
they
do
is
the
police
come
in
and
notify
people
that
the
encampment
will
be
permanently
closed
down,
and
they
have
found
that
this
has
been
successful
and
again
bear
in
mind
that
this
only
works.
H
If
the
services
have
been
available
and
made
available
to
meet
those
individual
needs
through
that
process,
as
a
result
in
San
Francisco
they're,
seeing
about
a
success,
sixty
five
six
percent
success
rate
and
people
accepting
safety
off
the
streets,
twenty
five
percent
of
those
have
exited
homelessness
and
they've,
seen
an
85
percent
reduction
in
tents.
Today
in
San,
Francisco
they've
resolved
23
encampments
comprised
of
944
people.
H
Obviously,
additional
resources
have
been
applauded,
deployed
to
achieve
this
success
and,
as
even
mentioned,
we
are
working
with
our
partners
at
DBH,
the
police
and
the
managing
directors
office,
to
establish
an
encampment
resolution
and
deploy
the
new
prevention
point
site.
As
our
navigation
Center
and
as
Eva
said,
we
can't
move
forward
and
make
this
plan.
We
can't
fully
develop
this
plan
or
make
it
public
until
we
have
shared
it
with
the
civic
associations,
and
we
are
beginning
that
process
tonight.
We've
tried
to
do
it
last
Wednesday,
but
everybody
knows
about
the
snow.
H
We're
also
going
to
need
everyone's
help
in
the
community
throughout
the
broader
community
to
redirect
their
generous
contributions
away
from
the
encampments
and
provide
the
meals,
move-in
kits
furniture
clothing.
To
help
people
transition
to
more
hey,
stable
housing
situations,
we're
developing
a
list
of
what
our
providers
can
use
in
the
hopes
that
everyone
can
help.
It
is
abundantly
clear
that
we
can't
solve
this
problem
alone.
That,
in
concludes
my
testimony.
Thank
you
again
for
this
opportunity
and
I
will
remain
available
to
answer
questions.
B
You
and
again,
as
I
said
from
the
beginning,
I
know
that,
particularly
over
there,
this
administration's
term
we've
seen
a
very
aggressive
approach
to
resolving
this
issues,
but
I
want
to
go
back
a
little
bit
before
we
move
forward
and
I.
Think
one
of
the
most
in
critical
points
of
this
is
understanding
how
we
got
here
around
some
of
the
what
dr.
Evans
used
to
call
a
saturation
of
services,
particularly
in
the
cousins
and
area
over
the
last
four
years.
B
The
federal
government
has
closed
several
mental
health
organizations
in
this
immediate
area
because
of
medical
and
non-compliance
issues
I'd
like
to
talk
a
little
bit
about
what
DBH
has
done
is
doing
has
changed
to
address
the
issue
of
quality
providers.
In
light
of
this
federal
intervention
that
was
necessary.
G
Thank
You
Councilwoman
Sanchez,
so
just
to
start
I
think
a
couple
points
I
think
are
important
to
make.
One
is
that,
while
what
we
try
to
do
is
make
sure
that
we
a
right
size,
the
service
array
for
a
particular
community,
and
so
while
I
think
the
perception
was
that
there
was
really
kind
of
maybe
a
saturation.
In
fact,
what
we
have
known
is
that
for
and
the
the
for
the
ten
districts.
In
fact,
you
guys
your
district
is
right
in
the
middle,
and
so
we
actually
have
always
felt
like
that.
G
We
needed
to
make
sure
that
we
were
being
as
responsive
to
the
members
needs
as
possible.
Second,
just
another
point
of
clarity
is
that
when
we
actually
have
worked
with
providers
who
have
had
challenges,
although
there
may
have
been
federal
intervention
it
would,
it
was
really
our
decision
ultimately
to
ask
them
to
leave
the
network,
and
so
that
has
been
the
prosthetic
that
continues.
The
other
thing
is
that
we
continue
first
and
foremost,
but
make.
B
B
G
The
the
the
board,
the
process
is
really
one
that
is
delineated
in
a
bylaws
of
community
behavioral
health
and
essentially
the
mayor.
Through
those
bylaws
points,
a
number
of
ex
officios
and
those
ex
officios
were
defined.
As
you
heard,
Eva
speak
up,
so
they
have
included,
for
example,
as
the
Commissioner
I
am
the
chair
of
the
board
for
community
behavioral
health.
You
actually
also
have
the
deputy
managing
director
Eva
Gladstein.
You
have
the
Commissioner
for
DHS.
B
G
G
G
B
Okay,
so
let's
talk
a
little
bit
around
the
quality
of
the
providers
and
ratings.
I
know
that
you,
particularly
in
over
the
last
couple
of
years,
we've
talked
about
similar
to
what
has
been
done
at
DHS,
creating
some
sort
of
matrix,
so
people
know
who's
in
the
system,
and
you
worked
and
I
think
in
April
of
2017
you
submitted
to
my
office
a
list
of
the
providers.
Is
there
an
easy
way
for
folks
to
see
who
are
the
providers,
how
much
money
they
get
and
what
they're
contracted
to
do?
Yeah.
G
So
I
think
that
we
go
through,
as
I
mentioned,
in
terms
of
any
quality
oversight
through
the
network,
improvement
and
accountability
collaborative
process
where
the
providers
in
our
network
are
credentialed
and
so
that
credentialing
typically
takes
the
form
of
either
a
six
month
a
year
two
or
three
year.
That
information
is
certainly
available
in
terms
of
who
the
agencies
are
that
are
in
I
network.
So
we
have
that
information
in
terms
of
the
the
broad
network.
It
also
indicates
typically
the
type
of
services
that
they
provide.
G
B
I
think,
if
I'm
a
resident
of
any
city
as
a
council
person,
this
is
the
question
I've
been
asking
for
ten
years.
Why
are
we
so
reluctant
to
share
this
information
publicly
about
who's
being
funded,
to
do
what
how
they're
credentialed,
if
they're
under
review,
if
they're
not
meeting
their
credential
status?
Why
can't
we
make
that
public
yeah.
G
G
So
I
have
two
responses.
One
is
that
so
for
any
of
the
members
who
are
looking
for
information,
so
we
actually
have
a
188
545
2,600
line
number
that
you
can
contact
as
a
member
at
any
point
in
time
and
and
we
both
request
services
and
ask
for
information
about
a
provider,
so
that
information
is
available
and
has
been
out
again
in
terms
of
a
credentialing
process
that
information
through
our
network
development
is
also
available.
G
And
so
we
you
can
contact
through
that
188
number
member
services
and
ask
for
network
development
and
again
get
information
specifically
about
a
provider.
We
have
really
focused
much
more
on
making
sure
that
members
have
an
understanding
around
choice
and
that
that
that
choice
includes
the
the
requisite
kind
of
cultural
and
linguistic
needs
and
and
an
array
to
then
be
able
to
accommodate
their
needs.
So
that
has
really
been
mostly
our
focus
so.
B
G
B
G
I
think
that
the
that,
as
it
pertains
to
non
profit
and
for
profits
that
information,
actually,
we
typically
share
that
through
our
minority,
women
and
disabled
owned
business
enterprise
information
that
is
updated
annually
and
so
certainly
I
think
that
information
is
available
and
then
I
think
that
the
board
is
likely
certainly
receptive
to
the
idea
of
making
board
meetings
more
public
I.
Think.
B
B
Think
one
of
the
problems
is
that
people
don't
make
a
distinction
between
one
type
of
service
and
another,
and
when
we
assure
residents
that
seventy
five
sixty
five
percent
of
the
folks
receiving
those
services
can
walk
there.
I
think
people
are
more
accepting
to
what's
going
on
versus
some
of
the
things
that
we
see
with
Athan,
Gerard
and
others
where
people
feel
those
types
of
services.
B
When
you
have
three
thousand
people
coming
to
one
service
provider
as
disruptive
and
so
to
the
extent
that
people
are
aware
of
who
are
the
providers
in
the
community
I
think
it's
just
better
for
all
of
us
right
people
need
to
know
and
I'll
give
you
an
example.
There
are
about
ten
providers
in
the
data
that
you
provided
me
there
about
ten
providers
with
budgets
of
over
a
hundred
million
dollars
within
a
blocking
distance
of
these
encampments.
B
If
I'm,
a
resident
of
this
community
I
want
to
know,
why
is
my
quality
of
life
being
disrupted
when
I
have
a
hundred
million
dollars
in
service
providers
in
this
area
and
part
of
the
reason
is
providers
do
different
things
right,
but
people
don't
know
how
to
make
that
distinction.
So
how
do
we
get
people
to
support
us
if
we're
not
being
public
if
we're
not
being
transparent?
B
If
we're
not
telling
people
how
people
get
credentialed,
if
we're
not
telling
people
who
are
the
service
providers
that
are
problematic
may
have
issues
with
their
credentialing
I
think
this
is
important.
I
think
there's
a
stigma
attached
to
Kensington
and
in
particular
the
barrio
around
these
service
providers,
because
they
close
up
and
then
another
sign
goes
up
multicultural
services
closed
three
years
ago.
There's
a
new
sign
up
there
that
says:
suboxone
I
have
no
idea
who
they
are
Yeah
right
and
so
I
have
to
answer
to
residents
and
I.
B
Don't
know
how
to
navigate
your
website
to
figure
all
of
that
out.
I
think,
there's
I
think
we
need
to
improve
how
we
inform
people
who
is
providing
what
service?
How
much
and
I
wanted
to
ask
you
one
more
thing
you
mentioned
I,
think
the
other
thing
that
I
want
to
make
clear
is
and
again
I
think
your
testimony.
Mr.
Jones,
you
talked
a
lot
about
a
lot
of
things
that
are
going
on,
but
the
fact
of
the
matter
is
a
lot
of
this
recently
just
started.
B
I
want
to
be
clear
that
it's
mostly
been
under
your
leadership.
This
is
not
something
that's
been
going
on
forever.
Some
of
the
service
providers
but
I
want
to
draw
in
particular
to
this.
We
are
also
supporting
eight
newly
funded
substance
abuse
disorder,
early
intervention
programs,
who
was
that
service
RFP?
What's
the
criteria?
Where
are
these
places
going
to
be
sited,
yep.
G
A
website
find
out
that
you
know,
X
provider
provides,
has
clinicians
trained
and
cognitive
behavioral
therapy
and
as
more
making
an
informed
choice
have
that
be
where
they
decide
to
go
and
seek
treatment.
So
I
wanted
to
be
real
clear
about
that.
The
other
issue
is
that,
as
we
are
talking
about
stigma
which
I
think
you're
absolutely
right
about
it,
it's
always
an
ongoing
concern.
I
think
where
we
also
have
to
be
careful
about
is
in
candidly
I
mean
I
will
be
candid.
I.
Think
that
there
is.
G
You
know
the
council
is
very
committed
to
addressing
this
issue,
but
sometimes
even
the
way
these
hearings
are
conducted
is
a
bit
stigmatizing
and
that
you
know
so
we'll
have
a
hearing
about
mental
illness.
We'll
have
a
hearing
about
addictions,
but
we
won't
necessarily
talk
about
diabetes,
asthma,
heart
diseases,
which
are
also
our
health
conditions
and
have
an
impact
on
the
community,
and
so
the
fact
that
we
have
these
hearings
and
again,
we
should
certainly
make
sure
that
David
Jones,
that's
the
Commissioner
for
the
Department
of
Behavioral,
Health
and
intellectual
disability
services
is
doing
everything.
G
G
I
also
wanted
to
to
just
underscore
the
point
around
the
us
being
as
a
department
really
receptive
to
figuring
out
what
the
needs
are
and
some
of
this,
and
you
know
and
I
appreciate
you
indicating
that
some
of
the
has
started
recently
and
then
some
of
it
actually
has
been
ongoing.
I
will
say
that
I
think
that
the
Department
of
Behavioral,
Health
and
intellectual
disability
services
has
a
pretty
comprehensive
network
of
services.
G
I
think
that
the
way
we're
structured
in
terms
of
community
behavioral
health
being
a
part
of
our
department,
I,
think
you
heard
Eva
mentioned
the
idea
that
that
there
was
only
about
a
7%
administrative
kind
of
expensive
expenditure.
But
the
other
thing
that
we
do
is
there
is
actually
there
is
no
other
health
plan
or
very
few
health
plans
in
the
country
that
does
not
retain
profit.
Community
behavioral
health
retains
no
profit
and
in
fact,
but
when
they
manage
well
within
3%
that
goes
back
into
Philadelphia.
So
it's
a
reinvestment
of
services
and
support.
G
So
then
we're
able
to
figure
out
then
what
are
those
additional
services
that
are
needed
and
make
a
reinvestment
in
the
community
and
then
and
if
I
can
make
this
a
final
point.
The
only
other
thing
I
would
say
is
that
93
cents
out
of
every
dollar
is
spent
on
medical
expenses
and
again
that
that
doesn't
happen.
Anyplace
else
in
the
country
and
so
I
I
just
want
to
emphasize
that
I
mean
that's
the
commitment
that
the
department
has
to
serving
Philadelphia.
B
Real
quickly,
because
I
think
it's
important
going
back
to
the
decision
making.
The
fact
is
that
we
have,
and
in
particular
in
those
in
those
budgets,
you
have
program
money.
You
have
fee-for-service
money
and
you
have
this
reinvestment
and
again,
when
I,
when
I
look
at
the
data
and
how
its
presented
to
us,
different
providers
get
different
money
and
there
doesn't
seem
to
be
a
matrix
for
that
and
you
talked
about
evidence-based
programming.
Are
you
funding
stuff
that
programming
and
what
is
the
correlation
between
again
I
want
to
learn
lessons
learned.
We've
closed
four
centers.
B
They
are
right,
I
mean
one
of
them
that
is
closing
now
March
31st
is
at
the
foot
of
gurney
Street,
there's
a
correlation
there
between
the
pipeline
of
new
addict
new
addiction
and
and
what
we're
doing
and
that's
what
I
want
to
learn.
What?
What
did
we
miss?
What
are
we
missing
in
the
connectivity
between
the
service
providers
that
were
shutting
down
we're
losing
their
license
and
some
of
the
challenges
that
we
face
in
the
community?
Yes,.
G
So,
just
to
again
you
you,
you
continue
to
ask
very
good
questions,
I'm
trying
to
respond
to
to
all
of
them
as
much
as
possible.
So
there
really
is
a
pretty
I
think
a
fairly
predictable
algorithm
to
our
funding
around.
So
you
know
we
actually
have,
as
we've
indicated,
Medicaid
dollars
that
come
in
Medicaid
dollars.
G
Now,
certainly
there
are
services
that
are
being
developed
that
are
more
evidence
informed.
They
haven't
necessarily
gone
through
the
scientific
scrutiny
to
become
evidence
base,
but
they're
evidence
informed
and
we
try
to
support
those
as
well,
so
I
think
that
is
a
process
and
then,
as
it
pertains
to
where
agencies
are
coming
up
again,
we
we
try
to
look
at
the
Philadelphia,
broadly
real
recognize
where
there
are
services
where
the
service
need
is
most
consistent
and
then
look
across
our
service
wait
array
and
bring
up
the
services
that
are
needed.
G
So,
for
example,
I
mentioned
that
we
have
a
you
know.
We
brought
up
partial
hospitalization
program
for
people
with
substance
use
disorder
that
had
been
a
service
that
had
not
been
in
our
array
and
had
long
had
been
sorely
needed.
We
also
brought
up
partial
hospitalization
for
children,
because
we
recognized
that
there
was
a
need
there
and
so
I
think
you
know
we
are
constantly
both
listening
to
what
the
community
is
saying.
G
We
are
looking
at
our
array
in
terms
of
a
service
array,
and
then
we
are
looking
at
trying
to
kind
of
match
those
against
where
services
need
to
be
developed
and
brought
up
and
that's
kind
of
how
we
go
through
and
it
typically
all
goes
through,
as
you
all
requested,
probably
some
six
years
back
or
so
a
procurement
process.
So
most
of
the
vast
majority
of
the
services
that
are
coming
up,
we
bring
in
via
a
procurement
process.
C
B
Multicultural
was
one
house,
and
then
they
bought
the
other
house
and
then
it's
two
houses
and
there's
fifteen
thousand
patients
I'm
even
looking
at
lower
hanging
fruit.
That's
that,
how
is
it
that
these
places
that
we've
closed
down?
You
know
what
are
the
points
where
you
start
saying:
wait
a
minute
where's
the
quality
when
you
have
thousands
of
people
being
I,
call
them
the
storefronts
right
and
this
little
front
office,
6,000
patients,
ten
thousand
patients.
Even
what
at
what
point?
Does
that
not
ring
a
bell
that
there's
a
problem?
Sure.
G
G
B
A
We'll
come
back
around
I.
Do
have
a
question,
though,
to
follow
up
on
the
councilwoman's
questions
and,
as
you
were
talking,
you
mentioned
that
the
network
of
care
was
on
your
website.
That
lists
who
the
providers
were
because
I
think
that
that's
really
critical
I
was
on
my
phone
I
can't
find
it
anywhere.
Okay,.
G
A
So
I
think
that
you
know
if
you
can
find
that
information
to
make
it
available
to
the
committee
into
the
public.
I
think
that
that
would
be
really
helpful.
One
of
the
big
problems
that
we
have
is
that
there's
a
lot
of
tax
money,
that's
being
spent
and
people
want
to
know
where
it's
going.
I
want
to
know
where
it's
going,
and
so
we
can't
get
the
programs
that
we
want
the
quality
programs
and
expand
those
programs.
A
I
I
think
it's
important
that
we
do
have
these
hearings
and
I
think
it's
important
that
we
really
dig
down
to
the
information
who
is
credible
and
who
was
not
credible,
who
has
issues
as
a
quality
care
provider
all
right
with
with
the
department
I
think
that
is
the
public
should
know
and
I
think
we
should
know
as
as
members
who
represent
people
because
we're
out
on
the
front
lines.
Just
as
as
you
are,
and
you
know
we
are
into
crisis
mode,
and
you
know
we
are
trying
to
confront
it.
I
You
know
not
as
a
as
somebody
that
is
in
in
the
industry
or,
but
somebody
who
cares
about
you
know
people
who
is
out
there
trying
I've
gone
to
pharmacies
in
my
district
and
with
every
single
pharmacy
in
my
district
and
asked
them
if
they
were
made
aware
in
conjunction
with
health
department
by
the
way.
So,
thank
you
and
derecha
point.
I
Or
are
they
aware
that
the
standing
order
that
there's
a
prescription
from
the
Pennsylvania
Surgeon
General,
then
anybody
can
walk
into
any
pharmacy
and
purchase,
whether
it's
insurance
or
privately,
no
lotsa,
all
right
and
what
are
they
doing
to
promote
it?
What
are
we
doing
in
our
community
groups
to
counter
this
stigma
of
somebody
who's
addicted
to
drugs
or
alcohol?
And
you,
you
know
we're
doing
it.
I
know,
I,
know
I'm
doing
it
and
I
know
well,
their
members
are
doing
it
and
I'm
ready
to
talk
about
it
publicly.
I
So
we
can
I
mean
this
is
2018
not
1918,
where
you
just
used
to
lock
up
people
all
right
in
code
mix
all
right
in
commingle,
their
populations
who
had
substance,
abuse,
drug
abuse
and
mental
disorders.
I,
don't
think
that
works
I,
don't
think.
There's
evidence
base
on
that,
and
but
that's
not
in
my
my
and
I,
don't
claim
to
know
what
the
best
way
to
treat
that.
But
you
know
the
commingling
of
I.
Think
population
is
somewhat
of
an
issue.
I
G
A
couple
comment:
councilman
Hina,
just
wanted
to
you
know
underscore
your
point
around.
We
also
think
it's
critically
important
that
for
in
particular
individuals
who
have
suffering
from
the
disease
of
addiction.
That
treatment
is
the
course
of
action,
certainly
as
opposed
to
incarceration
or
being
locked
up.
G
So
we
absolutely
share
that
and
I
think
that
you
know
it's
also
important
to
remind
you
know
everyone
that
the
the
state
certainly
does
the
licensing
of
agencies
we
work
very
closely
and
and
part
of
what
we're
trying
to
do
is,
as
I
mentioned
earlier,
around
medication,
assisted
treatment
and
evidence-based
practices.
We
recognize
that
there
are
several
pathways
of
recovery.
We
want
to
make
sure
that
that
people
have
broad
access
to
those
various
pathways
of
recovery.
G
Particularly
substance
use
disorder
needs
well,
and
so
we've
we've
done
a
lot
of
work
throughout
to
make
sure
that
the
information
around
medication
assisted
treatment,
as
is
being
included
again
within
each
level
of
care,
so
that
individuals
who
go
through
the
treatment
process
don't
necessarily
have
to
just
enter
through
a
detoxification
door.
I
think
that's
kind
of
the
evolution
of
how
treatment
services
are
being
provided
and
that's
kind
of
certainty.
That's
what
we're
committed
to,
and
so
you
know
we're
working
with
with
the
providers
to
share
their
information
and
to
achieve
those
outcomes
and.
I
You
said
you
mentioned
m80,
yes,
afterward
button,
all
right
so
before,
but
you
you
had
mentioned
that
there
are
other
providers
and
other
methods
of
treatment
that
some
tip
some
of
the
communities
may
have
had
some
positive
outcomes
with
some
other
wraparound
services,
and
you
know
for
for
me.
You
know
having
that
choice,
as
you
had
mentioned,
I
think
is
kind
of
important.
This
way
a
client
who
somebody
will
come
into
a
detox
right,
I
would
imagine
if
somebody
who
was
on
heroin
or
opiate
addiction
would
come
into
a
detox.
I
They
go
through
a
five
to
seven
day
detox
and
then
they
either
go
to
any
care
facility,
whether
it's
ma
T
or
right.
But
there
are
other
methods
of
of
trying
to
rehabilitate
yourself
from
this
insidious
diseases
all
right,
but
they,
let's
just
say
they
go
drug-free
very
for
X
amount
of
days,
whatever
the
level
of
care
so
I
think
there's
step-down
levels
right
like
a
3,
beta,
2
beta
and
then
when
they
want
to
have
after
care.
After
that,
they've
been
drug-free
they
automatically
if
they
want
to
have
cbh
as
a
father.
I
G
I
G
So
what
I'll
say
is
ultimately
an
individual
has
choice
in
their
their
kind
of
recovery
process,
and
so
that
you
know
so
it's
it's
not
a
absolute
that
you
come
through
any
level
of
care
and
you
have
to
participate
in
drug
free
or
you
have
to
participate
in
medication,
assisted
treatment,
I
think
it's
really
driven
largely
by
that
individual
in
their
work
with
their
their
treatment
team.
Again.
G
What
we
are
saying
is
that,
overall
again,
based
upon
what
the
science
is
saying,
is
that
individuals
who,
with
opioid
use
disorder
specifically
who
participate
in
medication,
assisted
treatment.
The
outcomes
are
much
better
again.
We
still
recognize
that
there
are
many
roads
to
recovery
and
want
to
give
that
flexibility.
We
just
are
saying
percentages
wise
again.
I
G
I
I
G
So
withdrawal
management,
essentially,
is
that
the
process
by,
as
you
were
talking
about
detox
detoxification
so
as
you
are
going
through
detoxification
or
I,
would
say,
withdrawal
management
of
the
chemical
that
you're
on
that.
That
could
happen
in
a
different
level
of
care,
as
opposed
to
it.
Just
being
that
you
go
through
detoxification
to
kind
of
detox
from
the
the
chemical
that
you're
on
and
then
go
into
treatment
that
we're
suggesting
that,
for
example,
that
can
happen.
G
G
I
My
last
question
and
I'll
yield
to
my
colleagues,
cuz
I'm
sure,
there's
a
lot
of
good
questions
and
and
I
think
you
know,
for
the
record,
all
right
nobody's
proclaiming
to
know
how
to
treat
people
all
right.
Just
that
you
know
there
are
some
neighbourhood
tips
in
the
communities
and
neighborhood
service
and
services
that
have
been
a
part
of
the
system
network
right
then.
So
there
are
some
choices.
G
So
two
responses,
one,
we
actually
I
think
in
terms
of
the
provider
network.
We
have
a
fairly
robust
of
provider
network
in
Philadelphia,
and
if
you
are
enrolled
in
Medicaid
in
Philadelphia,
then
actually
it
would
be
us
as
the
CVH
and
specifically
but
the
department,
broadly,
as
the
payer
for
services,
if
you
go
and
and
so
if
in
and
if
another
individual,
let's
this
is
an
arbitrary
example,
is
enrolled
with
Magellan
and
come
in
to
the
city,
then
magellan,
it
really
is
still
would
still
continue
to
be
there.
G
C
A
So
with
the
city
B,
so
we're
not
operating
and
we're
not
funding.
So
what
role
would
the
city
play
in
safe
injection
sites,
because
one
of
the
concerns
that
I
have
is
in
terms
of
liability
from
the
city
for
pregnant
users?
For
you
know
someone
who
drives
up
into
a
site
and
then
you
know,
uses
and
then
drives
off,
or
you
know
underage
minors,
all
of
which
you
know
can
and
does
happen
every
single
day
in
the
city
of
Philadelphia.
But
what
is
the
city's
role?
Would
the
city's
role
be
in
safe
injection
sites?
The.
C
Way
we
have
initially
outlined
it,
and
our
our
thinking
is
is
evolving,
so
I
don't
have
answers
to
those
particular
questions
was
that
the
city
would
help
facilitate
in
terms
of
identifying
potential
other
funding
sources,
perhaps
with
site
selection
and
certainly
with
providing
wraparound
services
to
any
such
site,
as
as
we
think
about
this
I
think
your
point
is
very
well
taken
and
we're
having
a
conversation
about
whether
or
not
there
are
certain
standards
or
criteria
that
that
would
need
to
be
developed
for
any
such
site.
Okay,.
E
A
That
that
would
be
really
helpful
as
we
have
this
discussion,
because
there's
just
so
many
unanswered
questions
and
you
know
I
get
beat
up
on
Twitter
about.
You
know
the
fact
that
I
have
questions
that
are
unanswered,
but
I'm
still
looking
for
the
answers
and
really
just
trying
to
make
sure
that
we
cover
all
of
these
things
and
I
do
think
that
before
you
know,
we
made
such
an
announcement
about
safe
injection
sites
and
the
desire
to
proceed
that
we
really
probably
should
have
had
some
of
these.
A
C
I
think
your
point
is
well-taken.
We
are
setting
up
a
series
of
community
forums,
starting
in
several
weeks
and
we'll
be
in
touch
with
every
member
of
City
Council.
We
have
four
for
which
we
have
scheduled
dates
and
locations
and
another
four
that
we're
working
on.
So
we
appreciate
that
recommendation.
I'll.
A
A
D
Jim,
thank
you
very
much,
madam
chair,
and
thank
you
very
much
to
you
and
Councilman
Canyon
as
Sanchez
for
this
important
hearing.
One
of
the
you
know,
I
think
that
we
have
put
an
enormous
amount
of
money
and
effort
into
addressing
the
consequences
of
opioid
prescription
over
prescription
and
I'm
curious
today
to
talk
a
little
bit
about
folks
who
don't
often
get
stigmatized
in
this
situation,
which
are
actually
the
doctors
and
the
hospitals
who
are
really
doing
some
aggressive
prescribing.
D
D
But
he
didn't
use
the
single
pill
and
he
didn't
really
need
one,
and
so
it
does
bring
me
to
ask
a
question
about
the
health
department's
plan
to
really
take
a
serious
look
at
holding
medical
providers
and
doctors
accountable.
I
know
in
your
testimony,
Commissioner
Fraley
that
you
said
that
you
have
mailed
out
guidelines.
You've,
mailed
out
dashboards
staff
have
visited
prescribers
and
you're
working
with
health
insurers,
but
you
know
as
well
from
the
report
that
it
sounds
like.
Other
cities
are
also
taking
extremely
aggressive
approaches.
D
I
think
Staten
Island
was
a
really
good
example
of
you
know
a
city
or
a
board.
That
was,
you,
know
three
to
four
times
higher
engaged
in
an
aggressive.
What
sounded
like
a
pretty
aggressive
campaign
and
I
guess:
I'm
I
want
to
give
you
some
time
to
flesh
out
how
you're
looking
at
some
of
these
things,
but
in
particular
you
know,
I
also
want
to
see
an
evidence-based
approach
towards
serious
education
of
our
medical
health
professionals.
D
They
are
the
ones
who
are
prescribing
these
opioids
that
get
people
started
on
the
kinds
of
addictions
that
then
lead
them
into
Street,
addictions
and
others,
and
it
just
feels
like
I'm,
very
curious
about
how
aggressive
it
is.
So
in
part
like
it
sounded
like
you
know,
there
were
aggressive
efforts
at
direct
training.
The
city
was
particularly
clear
about
addressing
direct
directly
with
providers.
I
know
you
have
staff
visiting,
but
I'm
curious
about
some
of
the
more
specifics
and
also
what
measures
of
what?
What?
D
What
ways
are
we
able
to
measure
the
efficacy
of
a
serious
campaign
and
at
the
end
of
the
result,
is
you
know
when
Staten
Island
did
this
aggressive
campaign
that
really
held
these
medical
providers
accountable?
And
some
of
you
know
our
doctors
who
are
very
prestigious
but
still
need
to
be
in
this
mix?
I
mean
they
have
to
be
at
this
table.
They
saw
twenty
nine
percent
decline
and
their
overdose
rate.
D
F
First,
I
completely
agree
with
you
that
doctors
prescribing
too
much,
and
the
example
you
gave
is
just
one
example:
that's
happening
all
over
the
city
and
I
frankly
find
it
shocking
that
it's
still
happening
this
part
in
the
epidemic.
One
would
there's
been
this
much
attention
drawn
to
the
over
prescribing
the
two
weeks
for
minor
surgery.
30
days
for
minor
surgery
is
completely
unnecessary.
F
This
has
happened
over
a
period
of
decades
when
those
doctors
have
been
encouraged
by
the
pharmaceutical
companies
to
prescribe
too
many
of
these
drugs
and
doctors
have
been
told
things
which
are
not
true.
They've
been
told
that
these
drugs
are
safe
and
effective
for
treatment
of
chronic
pain
when
they're,
neither
and
the
health
department
is
doing
what
we
can
to
try
to
change
that
practice,
which
has
occurred
again
over
a
period
of
decades.
F
So
we
don't
know
yet.
The
impact
I'm
prescribing
here
in
Philadelphia
I'm
hopeful
that
we're
gonna
see
a
continued
and
more
accelerated
decline
in
prescribing.
We
do
know
that
the
amount
of
prescribing
that's
taking
place
in
Philadelphia
is
going
down.
It
is
not
going
down
fast
enough
and
the
levels
of
prescribing
are
still
two
to
three
times
what
they
were
in
the
1990s.
F
So,
besides
this
I'll
say
aggressive
education
of
physicians,
a
stronger
step,
which
is
something
we
are
a
strong
proponent
of,
is
to
have
health
systems
or
health
insurers
put
rules
in
place
that
actually
make
it
a
lot
harder
for
physicians
to
prescribe
and
appropriately,
for
example,
have
an
insurance
company
not
reimburse
for
a
prescription
for
14
days
after
minor
surgery.
When
that
is
not
indicated,
we
haven't
strongly
encouraged
insurers
to
do
that.
Blue,
Cross,
Blue
Shield
has
a
policy
in
place.
F
The
other
Medicaid
insurance
plans
in
the
city
are
putting
in
place
policies
that
are
not
quite
as
strong,
and
we
are
hopeful
to
have
policies
in
place
for
every
insurer
in
the
state
and
sometime
the
next
six
months
to
a
year,
but
that
was
happening
through
our
encouragement.
Not,
though,
do
we
have
any
legal
authorities
to
do
that,
I
mean.
D
One
of
the
reasons
why
I
think
medical
providers,
apart,
perhaps
don't
feel
so
much-
is
that
there's
not
as
much
focus
on
them.
There's
like
a
tremendous
amount
of
stigmatization
of
communities
of
the
people
who
are
using
of
everything
else,
but
the
the
light
of
accountability
doesn't
feel
like
it's
shown
on
our
medical
community
as
well.
I'm
curious
about
I
mean
I,
understand
the
one-on-one
kind
of
engagement,
I
think
that
that's
highly
individualized
and
also
extremely
private.
D
It
sounded
like
some
of
the
work
that's
been
done
in
other
places
have
tried
to
bring
more
accountability
in
a
much
more
public
fashion.
So,
for
example,
a
convening
a
public
convenient
able
of
some
of
these
folks
is
also
particularly
another.
Another
way
to
recognize
that
this
is
not
just
gonna,
be
a
bunch
of
mail
that
you're
gonna
receive
or
private
visits,
but
the
city
is
actually
going
to
convene.
These
tables
is
actually
going
to
tell
people
specifically.
D
These
are
the
guidelines
so
that
it
echoes
not
only
to
that
individual
doctor
and
those
medical
providers,
but
it
also
echoes
out
to
other
people,
I
think
that
there's
been
a
lot
of
publicity
about
the
responsibility
and
onus
on
individuals
how
communities
have
to
handle
it,
how
this
city
has
to
pick
up
millions
and
millions
of
dollars
to
respond
to
it
and
very
very
little
on
the
flip
ends
to
say:
hey
doctors
in
the
lab
codes.
You
know
who
are
prescribing
these
things
where
you
know.
Where
are
you
and
this
accountability
scheme?
D
So
is
there
like
some
sense
about
how
to
make
it
more
public
in
terms
of
it's
not
so
much
like
I
know,
it's
not
so
much
like
bringing
them
here,
but
actually
the
city
convening
that
public
table
of
accountability
and
saying
these
are
the
guidelines.
This
is.
We
cannot
force
you,
but
we
are
exerting
our
public
leverage
to
demand
that
these
things
change
and
we're
counting
the
numbers
to
see
whether
it
is
changing.
I'm.
F
Not
quite
sure,
what's
the
process
you're
talking
about,
but
you
know
again
we're
using
every
lever
that
we
can
find.
If
you
have
suggestions
in
other
levers,
we
can
use.
I
would
be
happy
to
hear
them
because
I
agree.
This
is
a
this
is
what
is
feeding
the
problem.
This
is
what
has
probably
started
20
years
ago
that
is
ending
up
with
people
homeless
in
Kensington
and
we're
going
to
need
to
change
those
practices.
B
B
G
What
we're
also
doing
is
is
following
up
with
those
physicians
to
make
them
aware
of
what
they're
prescribing
patterns
are
against
other
Doc's,
so
we're
giving
them
information,
so
we
actually
have
begun
to
inform
them
in
term
of
kind
of
where
they
are
again
in
comparison
to
various
different
types
of
disciplines,
different
types
of
docks.
So
we
are
we're
giving
them
information
now,
so
then
help
them
correct
their
behavior.
But
if.
B
B
F
B
F
D
No
I
appreciate
that
I
mean
I,
think
that
there
are
questions
here
that
we
should
be
talking
about.
That
include
questions
about
disclosure
questions
about
you
know
tracking
and
analysis,
but
in
the
way
that
the
light
of
responsibility
and
onus
and,
to
some
extent
a
lot
of
personal,
blame
and
change
sometimes
has
shot,
has
shown
on
our
people
and
our
communities
I
need
that
to
shine
on
all
different
parts
of
the
spectrum,
with
the
same
kind
of
rigor
and
accountability
and
measures
of
efficacy
that
it
is
shining
on
everybody
else.
D
So
and-
and
you
know,
I'd
like
to
follow
up
with
you
a
little
bit
more
on
how
you're
measuring
the
efficacy
of
this
campaign,
in
particular
in
terms
of
its
reducing
I'll,
have
one
more
quick
question.
Although
I
don't
know
if
we
have
somebody
here
who
can
analyze
this
a
little
bit
but
I
don't
know
if
this
is
if
this
works
for
for
commits
or
Gladstein,
but
could
you
I?
C
Begin,
although
I
think
David
may
also
be
able
to
add
to
this,
and
we've
announced
some
some
of
these
interventions,
certainly
with
piloting
a
new
program
in
the
schools
where
we'll
be
putting
eventually
teams
of
four
people
in
each
school.
But
it's
still
very
much
at
the
pilot
phase
right
now
to
provide
support
for
the
school
environment.
G
So,
and
we
certainly
agree
with
the
idea
that
you
we
want
to
make
sure
that
services
are
going
to
the
entire
family
and
and
so
to
that
end,
there
are
a
couple
of
things
that
are
happening
in
counseling
Jim
you're,
aware
of
these,
so
part
of
the
the
just
in
terms
of
our
health
promotion.
We
certainly
have
tried
to
get
out
front
and
done
more
of
the
work
with
mental
health
first
aid,
and
so
there
is
actually
a
curriculum
that
actually
is
more
youthful
focused.
G
We've
actually
also
provided
prevention
services
to
about
30,000
youth
over
within
about
90
schools
and
those
are
the
Charter
and
peripheral
as
well
with
the
idea
again
trying
to
show
up
and
help
with
resilience.
Some
of
that
has
it's
been
brought
broader
than
trauma-informed,
but
that's
been
a
part
of
the
some
of
the
curriculums
that
we've
been
using.
Some
of
it
is
is
around
certainly
bullying
prevention,
but
we
feel,
like
kind
of
it's.
D
So
I
am
more
interested
in
the
city's
departments
being
much
more
strategic
and
directional
about
its
investments
for
kids.
So
we
know
generally,
like
the
field
of
trauma,
is
highly
needed.
I'm
talking
specifically
related
to
this
crisis.
We
know
that
there
are
children
and
families
who
are
struggling
in
specific
neighborhoods
with
schools
right
there
in
them.
Dealing
with
those
crises,
I
have
gone
into
a
number
of
the
schools.
I
have
talked
to
those
teachers
who
will
tell
you
directly
about
the
trauma
they're
experiencing
with
this
children
that
are
happening.
D
We
know
where
those
schools
are
so
I,
don't
want
to
talk
about
like
a
generic
kind
of
approach
or,
let's
superintendent
height,
and
you
work
out
a
bunch
of
programs
I'm,
asking
more
specifically
about
investments
directed
to
specific
schools
in
the
in
the
areas
that
are
directly
hit.
So
one
great
example
I
will
give.
D
This
is
the
partnership
that
we
had
with
cbh
to
identify
22
schools
that
would
receive
a
social
worker
in
them,
for
example,
that
would
be
servicing
more
towards
a
whole
school
community
who
could
help
work
with
with
the
school
community,
as
opposed
to
like
being
targeted
around
individualized
students
and
I'm
wondering
whether
your
department
is
looking
specifically
at
making
sure
that
public
schools
are
specifically
hit
by
the
opioid
crisis
and
we
know
where
they
are
based
on
their.
You
know
they're
in
the
epicenter
of
it
those
teachers
are
in
the
epicenter
of
it.
D
Those
children
are
experiencing
it
on
a
day-to-day
basis
when
they
walk
to
school,
when
they're
going
back
home
to
their
families.
When
they're
walking
back
back
and
forth
what
specific
investments
are
you
making
I
could
list
the
schools
if
you
want,
because
I
want
to
know
that
these
kids
need
help,
and
so
do
those
teachers
they
need.
It
I
hear
it
all
the
time
yep.
G
So
the
the
it's,
the
it's,
the
intervention
that
Eva
reference-
and
you
just
mentioned
specifically
so-
the
support
team
for
education,
a
partnership
that
step
program.
We
certainly
that's-
you
know,
as
cbh
as
a
part
of
a
we've,
been
very
much
at
the
table
around
the
planning
for
that
I
think.
The
other
piece
that
I
just
mentioned
in
my
testimony
are
the
eight
newly
funded
those
for
those
providers.
I
can't
specifically
delineate
whether
they're
going
to
be
in
schools.
G
We
can
certainly
look
at
that
and
get
back
to
you
about
if,
in
fact,
that's
happening,
but
certainly
the
idea
and
that
approach
is
to
work
with
families
to
provide
a
kind
of
individual
group
and
family
therapy
for
for
folks
who
are
experiencing
kind
of
any
challenges
as
they
read
as
they
pertain
specifically
around
a
substance
use
disorder.
So
we
are
I,
think
going
to
build
on
the
idea
of
step.
I
mean
step.
The
whole
approach
is
is
also
to
be
able
to
look
more
broadly
at
within
those
22
schools
to
look
at
school
climate.
G
In
addition
to
being
able
to
provide
some
consultation,
support
for
individuals
who
may
be
experiencing
benefit
various
types
of
psychiatric
stress,
so
we
are
again
committed
to
that.
What
I
would
as
I
responded,
I
wanted
to
give
kind
of
both
kind
of
a
bridge
and
then
some
more
specific
things,
because
I
think
that,
while
we're
dealing
with
this
crisis
right
now,
there's
yet
to
be
a
one
that
we
haven't
necessarily
anticipated
and
so
to
the
extent
that
we
can
get
in
front
of
that
and
help
folks
to
be
more
resilient.
G
D
That's
what
this
hearing
today
is
about
I
think
it's
extremely
important,
those
young
people
you
want
to
talk
about
crisis,
it's
the
young
people
who
are
growing
up
watching
it
right
now,
who
are
then
gonna
become
teenagers
and
young
adults
trying
to
figure
it
figure
out
where
the
city
was
for
them
when
they
needed
it
the
most
when
they
were
five
and
six
years
old.
So
thank
you.
A
Thank
You
Councilwoman
I
just
want
to
do
a
couple
things
number
one
I
want
to
recognize:
councilman,
alte
hamburger.
Also
we
have
our
city
controller,
Rebecca,
Ryan
Hardy,
who
has
joined
us.
So
if
we
could
have
her
come
and
give
our
testimony
and
then
we'll
go
to
councilman,
scuola
and
then
councilman
Jones
in
the
back
to
the
panel.
A
E
Reinhart
city
controller,
thanks
for
having
me
here
today.
Thank
you
good
morning,
Councilwoman
bass,
chair
of
the
committee,
Councilwoman
Maria,
kono
Sanchez,
and
members
of
the
Public
Health
and
Human
Services
Committee.
My
name
is
Rebecca
Reinhard
I'm,
the
city
controller
I,
am
here
today
to
testify
on
resolution.
E
One
eight
zero,
zero,
three
seven,
which
authorizes
the
Committee
on
Public,
Health
and
Human
Services,
to
hold
hearings
to
assess
the
City
of
Philadelphia's
efforts
as
coordinated
by
the
managing
directors
office
in
our
Human
Services
departments,
to
prevent
and
treat
abuse,
addiction
and
disease
related
to
the
use
of
opioids
in
2017.
More
than
5,000
Pennsylvanians
died
from
drug
overdoses,
about
1,200
of
those
lives
lost,
or
here
via
the
opioid
epidemic
is
a
serious
problem
facing
our
city.
E
In
January
of
this
year,
I
announced
that
my
office
would
conduct
a
performance
audit
of
the
Department
of
Behavioral
Health
and
intellectual
disability
services.
This
audit
of
dvh
IDs,
which
has
an
annual
budget
of
about
1.6
billion,
will
assess
the
validity
and
effectiveness
of
their
spending
DBH,
largely
contracts
out
the
services
it
provides
to
individuals
through
nonprofit
agencies.
E
The
audit
was
specifically
specifically
probe
the
provider
selection
process,
the
effectiveness
of
the
services
provided
and
the
process
for
determining
how
much
funding
a
provider
receives.
Among
other
factors,
the
opioid
crisis
is
a
complicated
issue
with
no
easy
solutions.
The
goal
of
our
audit
is
to
understand
how
the
department
is
spending
money
on
addiction
services
and
to
ensure
that
the
money
is
being
spent
wisely
responsibly
and
efficiently.
E
A
J
C
J
C
J
And
the
state
has
called
this
an
emergency
correct
and
we
had
some
concerns.
We
know
the
budges
1.6
billion
dollars,
which
is
a
good
sum
of
money
and
thank
you
for
the
control
or
looking
at
those
dollars
to
see
how
it's
spent,
and
we
appreciate
your
help
on
that,
but
the
state
that
is
considered
an
emergency.
Are
they
now
offering
additional
dollars
to
the
city
to
help
fight?
This
no.
C
G
I
think
to
the
point
that
you
also
are
raising
around
of
the
potential
growth
I
mean
what
so,
what
we
anticipate
and
what
we
would
like
to
see
included
even
in
the
health
choices
rates.
Is
you
know
to
make
sure
that
we
have
the
rate
that
would
address
the
additional
capacity
that
we
would
need
to
to
deal
with
kind
of
the
the
new
services
that
we
would
need
to
bring
up
to
to
address
the
issue
now.
G
There's
a
there's,
a
capitation
arrangement
that
that
comes
the
so
the
dollars
that
essentially
come
from
from
federal
to
state
and
from
state
to
the
city
via
Department
of
Behavioral
Health
and
elects
with
disability
services.
The
city
actually
manages
the
capitation
risk,
and
so
what
happens
is,
and
we
then
contract
with
cbh,
which
gets
so
much
per
member
per
month,
and
that
per
member
per
month
rate
includes
the
cost
of
providing
medical
services
to
medical
behavioral
health
services
to
those
individuals.
G
So
we
are
expected
to
manage
within
that
rate,
and
so,
whatever
services
that
are
needed
to
be
provided,
and
so
what
we
found
is
that
of
the
rate
that
the
state
has
proposed
in
terms
of
that
health
choices
rate
is
not
adequate
to
cover
all
of
our
needs,
particularly
after
we,
as
we
may
have.
Some
expansion
needs
based
upon
the
growing
array
of
folks
with
substance
use
disorder.
So.
G
I
think
what
what
happens
is
that
you
know
we
we
go
through,
certainly
as
we
expand
the
provider
network.
That
would
be
a
procurement
process
and
certainly
if
we
needed
to
have
additional
services
brought
up
if
the
an
adequate
to
cover
additional
services,
and
certainly
it
would
have
an
impact
on
on
the
both
the
services
and
potentially
providers
coming
into
the
network
and.
C
If
I
could
just
add,
we've
discussed
this
a
little
bit
with
counsel
in
school.
I
want
to
make
sure
the
other
members
of
counsel
are
aware
that
the
capitation
that
we
originally
provided
by
the
state
several
months
ago
was
was,
we
thought,
really
significantly
deficient.
It
was
less
resources
than
we
spent
in
16
and
in
calendar
year,
16
and
in
calendar
year.
What
we're
finalizing
for
calendar
year.
17
we've
had
a
number
of
conversations
with
the
state,
they've
added
more
resources,
but
we
still
anticipate
a
significant
gap.
G
J
Because
we
had
asked
and
reached
out
the
secretary
Miller
to
come
down
to
the
meeting
and
unfortunately
she
wasn't
able
to
come,
but
she
did
say
that
we
have
her
statement
was
with
in
an
email
that
we
have
had
numerous
calls
and
meetings
with
correspondence
regarding
20:18
rates
for
DBH
cbh.
We
have
also
asked
for
some
additional
information
on
the
proposed
initiatives.
We
have
also
assured
both
mr.
Jones
and
and
Ernie
Jones
I'm,
sorry,
that
we
will
review
the
rates
again
at
mid-year
to
ensure
adequacy.
G
J
F
Certainly
seeing
an
increase
in
overdose
deaths,
obviously
we
don't
have
a
way
of
counting
how
many
people
out
there
are
using
heroin
or
injecting
heroin.
We
have
survey
data
that
can
give
us
an
estimate
of
how
many
there
are,
and
so
our
impression
is
based
on
the
number
of
people
overdosing
that
probably
at
number
is
increasing,
but
we
don't
have
a
hard
count
to
track
that,
but.
I
I
F
Survey
that
we
did
last
summer
suggested
at
a
hundred
and
sixty-eight
thousand
people
in
the
city
of
hundred
sixty
eight
thousand
adults
were
currently
taking
prescription,
opioid
pills
and
not
all
those
people
were
addicted,
but
probably
a
lot
of
them
were,
and
so
that's
it's
a
lot.
It's
a
huge
number.
That's
represents
one
in
seven
adults
in
the
city,
so.
I
When
you
look
at
you
know,
future
growth,
you're
you're,
look
at
yummy.
You
can
start
with
that
all
right
and
and
then
go
from
there
to
see
what
kind
of
reimbursements
we
need.
What
kind
of
treatments
you
know
we
would
need
in
how
to
estimate
some
sort
of
financial
budget,
for
you
know
trying
to
deal
with
opioid
addiction
is
that
would
that
be
correct?
Well,.
F
The
number
is
huge,
and
now
a
number
of
those
people
will
end
up
not
going
through
a
formal
treatment
program.
That's
one
of
the
things
we
do
know.
Some
people
do
just
stop
on
their
own,
so
it's
hard
to
predict
how
many
of
those
will
ultimately
need
treatment,
but
certainly
in
the
need
for
treatment
is
very
large
and,
and
so
any
limitations
on
funding
for
the
city
is
going
to
be
real
problem.
Alright,.
I
And
latest
plenty
of
information
council
apologize,
maybe
in
your
time
the
rate
of
reverse
Minh
that
the
feds
take
you
know
pass
through
to
from
the
state
down
to
the
municipality,
which
is
City
Philadelphia
to
your
department.
What
are
the
difference
in
percentage
of
rates
and
dealing
when
how
you
treat
somebody
with
addiction,
substance,
abuse
addiction?
So
is
there
a
higher
rate
in
treating
with
m80
that
there
is
dealing
with
other
supportive
services
that
are
drug-free.
J
J
G
What
what
we're
against
o,
what
we're
able
to
what
we
know
is
that,
again,
probably
if
an
individual
has
chosen
medication
assisted
treatment
that
they
are
again
are
twice
as
likely
to
to
then
come
through
kind
of
the
treatment,
recovery
process
and
then
and
not
necessarily
relapse,
and
so
and
and
although
we
recognize
that
certainly
relapse
is
a
part
of
kind
of
the
recovery
process.
We
are
finding
that
individuals
again
who
choose
medication,
assisted
treatment
along
with
the
additional
therapies
again
progressed
more
through
their
recovery.
G
So
again,
what
we're
saying
is
that,
just
in
terms
of
the
recovery
process
that
these
individuals
so
we're
finding
that
they
don't
necessarily
they
don't
overdose
and
and
certainly
obviously,
if
you're
not
overdosed,
and
then
we
don't
necessarily
we're
not
experiencing
seeing
individuals
who
then
choose
m80
experienced
a
death
of
someone
who
may
have
just
selected
detox
alone.
So.
G
G
G
J
E
D
E
Rate
is
is
not
a
renewal
of
the
use
of
illegal
drugs
and
so
and
so
to
begin
there,
that's
the
baseline.
If
you
want
to
talk
about
success,
so
if
I'm,
not
if
I'm
not
no
longer
using
illicit
drugs
and
if
I
am
now
beginning
to
you
know,
we
captured
my
life
and
that's
about
that's
a
part
of
the
long-term
recovery
and
I
think
that
we
need
to
be
clear
about
that's
the
business
that
we're
in
we're
in
the
business
of
not
just
treating
someone
but
long-term
recovery.
E
Alpha
is
we
have
a
higher
probability
of
long-term
success
in
terms
of
recovery.
Is
that
so
that
means
that
it's
possible
that
you
may
have
an
episode
here
or
there
or
somebody
who
goes
back
to
using
an
illegal
drugs,
but
it
doesn't
it's
not.
Sustainable
episode
is
usually
what
happens
is
for
many
people
that
relapse
is
a
part
of
their
river
of
their
long-term
recovery
and.
J
E
E
E
Are
some
people
who
actually
go
into
treatment?
They
relapse
and
then
you
don't
see
them
anymore
until
they
are
in
a
crisis,
but
you
have
other
people
who
may
go
into
treatment
who
are
getting
good?
You
know
good
responsible
treatment
and
they
may
have
an
episode
where
they
do.
You
know
when
you
pick
up
again
and
but
the
issue
is
a
they
stay
in
treatment,
they
resolve
the
issue
and
they
and
they
eventually,
you
know,
are
able
to
sustain
their
recovery
process
and
you.
J
J
E
Getting
off
of
method
on
is
a
small
number
by
comparison.
Did
this
say
for
the
sake
of
argument:
you
have
about
six
thousand
people
in
the
city
of
Philadelphia
between
five
and
six
thousand
people
who
are
on
methadone,
so
the
question
would
be:
is
whether
or
not
you
know
those
folks?
What
percentage
of
those
folks
ever
come
off
of
method
on
and
I
would
tell
you
at
this
point
in
time
that
you're
talking
about
a
very
low
percentage
abroad,
because
they.
J
E
E
J
And
we
still
I
guess
we
still
don't
see
a
decrease
in
Odie's
or
people
becoming
I,
guess
productive
in
society
on
that,
so
we're
keeping
people
we're
not.
But
the
reason
why
I'm
saying
that
is
we
had
a
couple.
Mothers
come
to
my
office
and
individuals
who
wanted
to
try
to
get
off
the
m80
and
it
was
then
brought
to
them
that
they
had
did
not
want
to
try
to
advise
them
to
go
to
win
their
source.
Yeah.
G
So
what
I'm
going
to
ask
real
quick
is
actually
I've
one
of
my
medical
directors
to
come
up
to
be
able
to
respond
to
some
of
the
questions.
Okay,
good.
K
Night,
Ernie
Martin
councilman
Squealer
good
morning
to
the
council,
I'm
dr.
Jeffrey,
Neimark
I'm,
the
chief
medical
officer
at
cbh.
Thank
you
for
this
opportunity
and
for
the
question
I
just
wanted
to
respond
in
the
following
way:
the
their
various
outcomes
around
medication
assisted
treatment.
The
two
times
one
that's
being
talked
about
here-
is
really
about
achieving
abstinence
over
a
set
interval.
K
If
you
were
to
compile
all
the
outcomes
on
m80
which
have
been
really
robustly
shown
across
a
wide
range
and
that's
everything
from
fatal
overdoses,
lowering
HIV
and
hepatitis
rates,
community
safety
and
a
range
of
others
we'd
be
happy
to
provide
you
with
that
information.
I
think
one
of
the
dangers
in
terms
of
this
discussion
is
getting
into
a
rehashing
of
the
debate
around
whether
m80
is
effective
or
not.
That's
been
proven.
We
actually
are
moving
now
to
I.
J
Said
one
thing:
real,
quick,
because
this
is
the
same
argument
is
being
used
for
the
safe
injection
sites.
If
we
had
everybody
freely,
go
in
and
shoot
heroin
right,
they
wouldn't
die
because
they
were
being
there
to
be
monitored
and
we
would
keep
them
alive.
So
it's
a
harm
reduction
strategy.
Correct
so
I
mean
the
same
thing
is:
if
we
just
had
everybody
and
just
say:
alright,
everybody
just
go
shoot
heroin
and
nobody
would
ever
die.
That
would
be
better
than
method
on
that
would
be
better
than
vivitrol.
That
would
be
better
than
everything.
Well,.
K
Hey
look
I
think
if
you're
looking
at
a
harm
reduction
model,
you
can
look
at
other
municipalities
and
countries
who've
adopted
the
practice
you
are
talking
about,
I
think
we're
talking
about
a
medicalized
model
around
methadone,
around
suboxone,
around
vivitrol,
that's
highly
effective
and
that
works
and
then
at
the
end
of
the
day,
saves
lives
and
that
the
more
we
argue
around,
whether
it
works
or
not,
the
less
likely
we're
going
to
get
to
a
point
where
the
outcomes
we
want.
We
achieved
I.
J
G
But
I
think
just
to
just
add
I
think
that
again
the
the
risk
here
is
that
you
know
so.
We
are
raising
the
the
conversation
around
medication,
assisted
treatment
and
we're
talking
about
methadone,
buprenorphine
vivitrol
as
it
retains
to
opioid
use
disorder.
If
we
were
to
if
we
would
have
changed
the
conversation
around
the
disease
and
say
so
now,
we
are
then
talking
about
cancer,
and
we
want
to.
We
want
to
prevent
the
spread
of
breast
cancer,
and
so
we
have
somebody
that's
on
tamoxifen
right
and
then
you
would
say
so.
G
G
Think
that
the
the
principle
of
irrespective
of
the
of
the
disease
is
what
we're
trying
to
do
so
here
we're
saying
medication,
assisted
treatment
is
effective
in
helping
a
person
to
again
achieve
a
long
term
recovery
we
do
do
we
keep
them
on
it
forever.
I
think
it
depends
upon
kind
of
what's
working,
but
again,
at
the
end
of
the
day,
we
want
to
make
sure
that
they
are
able
to
then
have
you
know,
a
sustained
life,
that's
of
quality.
J
I
mean
nobody's
opposed
the
medical
assistant,
treatment,
I
think
as
a
means,
and
but
there
should
be
some
other
ways
to
maybe
do
men
try
to
beat
people
eventually
off
that
who
want
to
get
off
it
and
who
want
to
go
out
to
a
more
maybe
sober,
living
or
drug-free
living,
and
it
seems
like
we
are
pushing
more
the
other
way
and
it
we
don't
when,
when
you
get
some
of
the
answers
that
we
get
is
like,
how
do
they
get
off
a
method
on?
You
say:
why
do
they
have
to
get
off?
J
You
know
and
that
to
me,
some
of
these
people
do
want
to
I
mean
the
kids.
We
talk
to
the
parents
we
talk
to
and
they
seem
like
they're
being
pushed
more
into
that
level,
even
though
they
want
to
get
off
it,
and
that's
my
concern.
It's
not
that
whether
we
use
m80
or
not,
it
just
seems
like
we're
going
to
an
avenue
where
it's
going
to
be
constant
medication
and
medication
forever,
and
that's
the
part
that
scares
me
and
and.
K
I
think
I
agree
with
that.
You
know
as
a
physician
at
the
end
of
the
day,
I
know
if
you
cannot
be
on
a
medication-
that's
always
better
than
being
on
one.
However,
if
you
need
one
for
your
for
your
well-being,
for
your
functioning
and
for
everything
else,
that's
an
individualized
decision
that
we
would
encourage
treatment
providers
to
make
with
our
members.
What
we
are
advocating
for
is
for
our
providers
to
offer
informed
consent
to
a
treatment
that
works,
we're
trying
to
break
down
stigma.
K
J
I
agree
and
I
think
that
should
be
an
option
and
I
think
it
should.
We
could
still
I
mean
because
we
talked
about
it.
We
have
doctors
out
there
and
and
Councilwoman
Sanchez
and
myself
both
have
doctors
out
there
that
weren't
participating
in
the
insurance,
but
dr.
Somers
and
dr.
VAR
Dell
who've
been
actively
supposedly
helping
our
addicted
population
that
have
been
taking
advantage
of
them
and
it
took
us
five
years
to
get
them
to
go
to
jail.
J
But
I
mean
these
are
things
that
we've
been
working
on
and
it's
just
frustrating
because
the
big
push
toward
medicine
and
yes,
medicine,
we're
big
proponents
of
medicine.
We
wanted
to
help
people,
but
there
are
a
big
group
of
people
who,
after
taking
medicine,
want
to
try
to
get
off
of
it
and
I
think
that
yeah,
if
you
want
to
do
medicine,
free
I,
think
that
should
be
an
option
and
I
think
even
medicine
initially,
and
then
we
in
its
way
off
to
be
medicine
free.
That
should
be
an
option,
but
just
not
right
now.
J
J
I
mean
I,
hear
you
say
that
both
some
of
the
kids
that
tell
you
when
they
go
in
there,
they
don't
have
a
choice,
they
put
them
right
in
their
Mayte
and
that's
something
we
and
maybe
the
controller,
to
be
able
to
find
this
out
by
doing
interviews
by
seeing
that.
Why
are
our
people
doing?
That
I
mean
that
reflects
back
up
on
you
and
if
that's
the
case,
what
are
we
doing
as
a
city,
yeah?
Okay,
thank
you.
Thank.
A
You
know
without
resources,
so
I
just
wanted
to
put
that
out
there
as
well
just
a
couple
of
quick
things:
we're
getting
ready
to
lose
our
city
controller.
So
for
the
members
I
don't
know.
If
anyone
had
any
specific
questions
for
her,
you
do.
Okay,
can
you
hang
for
just
a
few
more
minutes?
Okay,
so
councilman
Jones
is
next
and
then
councilman
tongan,
burger
and
councilman
curry.
Maria.
A
And
one
other
thing
I
just
want
to
announce
just
so.
Everyone
knows
that
this
is
not
the
end
of
the
conversation.
Our
next
hearing
on
this
matter
will
be
on
April
4th
from
5:30
to
7:30
at
the
Cardinal
Bevilaqua
Center
at
26:46
Kensington
Avenue.
So
we
certainly
hope
folks
will
be
able
to
attend
that
hearing
as
well.
So
this
is
not
the
end
of
the
conversation,
so
councilman
thank.
L
Thank
you
for
bringing
that
I
had
the
unenviable
displeasure
of
burying
Nasser
Fatah
last
week
who
died
of
an
opioid
addiction,
he
was
found
in
sister
fellows
other
part
of
the
block,
having
been
in
his
room
for
two
days
and
no
one
knew
he
was
in
there.
We
just
put
him
to
rest
and
the
shame
of
it
is
I
didn't
know
he
was
addicted
to
opioids
and
he
seemed
just
fine
to
me,
and
so
it
is
a
problem
that
has
different
faces.
Some
people
are
able
to
mask
it
better,
but
it
is.
L
My
good
colleague,
Kenyatta,
Johnson
and
I
are
always
talking
about
gun
violence,
but
when
you
gave
it
us,
this
statistic
of
1,200
deaths
last
year,
put
it
in
in
perspective
that
this
is.
This
is
a
tidal
wave
that
we
need
to
address
a
couple
of
things
and
thank
you
for
the
other
things
you
do.
If
I
have
it
correctly,
your
department
is
more
of
a
gatekeeper
of
funds
and
insurances
that
you
subcontract
out
to
other
entities
to
deal
with
specific
services
that
are
required.
Is
that
true?
That's.
L
L
I
think
that
the
city
controller,
on
the
stage
of
her
swearing-in,
made
that
one
of
her
priorities
to
kind
of
take
a
look
at
that
because
it
represents
such
a
large
portion
of
our
expenditures
as
a
city
and
I
think
are
for
that
because
the
the
point
is
and
that
shouldn't
be
met
with
fear,
but
it
should
be
replaced
with
facts
and
the
reason
I
say.
That
is
because
everybody
in
this
chamber
wants
to
do
good,
I,
believe
it.
L
L
That
is
a
that
is
that
is
the
elephant
in
the
room
for
me
that
at
the
end
of
the
day,
there
should
be
a
end
of
the
day,
hopefully
with
a
happy
ending
that
people
are
successfully
get
out
of
there
edition
and
go
back
and
I
know
some
to
use
the
term.
Some
of
my
best
friends
are,
but
some
of
my
best
friends
were
in
that
situation
and
actually
did
find
their
way
through
it
through
God
through
spirituality,
the
programs
that
exist
out
there
but
managed
that
way
through
it.
L
L
You
gave
me
some
statistics
about
demographics
of
the
addiction
processing
and
those
people
that
lost
their
lives
to
it.
I
want
to
dig
down
into
that.
The
other
question
that
a
lot
of
people
bring
to
me
is:
where
are
they
from
RT
from
Bucks
County,
Montgomery,
County,
New,
Jersey
and
I
found
out
from
you
that
they
may
well
still
be
mostly
Philadelphia?
Is
that
correct?
G
L
I
have
a
Recovery
Center
in
my
district,
it's
not
just
Councilwoman
Sanchez
and
I
want
to
do
good.
I
need
and
I
want
to.
Thank
you
for
helping
me
with
one
of
them,
which
I
won't
name,
that's
right,
but
there
are
some
unintended
consequences
that
happened
with
those
centers
and
that
I
need
you
to
pay
keen
attention
to
my
I
funded,
more
macdo
macdonald
franchises
in
the
city
of
philadelphia
and
ronald
mcdonald
himself.
That
was
a
part
of
when
I
was
at
PCC.
E
L
L
You
will
not
do
that
because
they're
our
brothers
and
our
sisters
and
they
need
our
help,
but
also
what
I
want
to
encourage
in
other
parts
of
other
communities
is
that
you
do
like
you
did
for
Parkside
where
you
intervene
and
let
people
know
that
we
have
to
be
good
neighbors
and
wherever
you're
talking
about
put
news
in
Jackson
centers,
they
have
to
have
good
neighbors.
The
people
who
pay
you
know.
L
Private
investment
into
residential
properties
they're
from
so
a
leg
on
the
stool
of
recovery
and
treatment,
has
to
be
how
those
centers
fit
into
surrounding
community.
And
if
you
do
that
by
the
budget
time
and
come
up
with
that
brilliant
plan,
I
won't.
Consider
you
geniuses,
okay,
but
anything
I
vote
on
has
to
include
that
other
places.
L
I
know
do
that
kind
of
service,
and
they
do
it
quite
frankly
for
a
lot
less
and
they're
a
part
of
that
community,
whether
it's
snow
removal,
whether
it's
cleanups,
whether
it's
barbecues
and
donating
the
the
hamburgers
and
hotdogs
I,
know
this
to
be
true,
but
that
has
to
be
a
key
component
in
any
Recovery
Center
needle
exchange
in
Philadelphia
and
I'm.
Going
to
stop
with
that,
because
she
said
be
brief,
but
I'll
give
you
enough
time
to
answer
it
during
budget.
Thank
you,
madam
chair
Thank.
E
You,
madam
chair,
lady
and
I,
want
to
thank
you
and
Councilwoman
Quinn,
Tony,
Sanchez
and
councilman
swill
up
and
Councilman
DOM
for
bringing
this
issue
to
our
attention.
So
we
can
have
a
an
understanding,
a
better
understanding
than
this
I'd
like
to
just
talk
about
a
couple
things
on
on
statistics.
It
was,
it
was
testified.
There
are
about
70,000
heroin
users
in
Philadelphia,
I
just
want
to
create
if
I'm
wrong.
Please
correct
me
out
of
the
deaths.
It
was
just
testified
a
moment
or
two
ago
90
percent
are
from
or
from
Philadelphia
County.
E
F
F
Yes
right
and
that's
a
surveys,
self-report
it's
less
than
perfect,
but
it's
the
best
we
have.
We
do
have
good
data
on
the
people
who
died
from
overdose
because
we
get
statistics
from
the
medical
examiner
and
we
can
get
you
a
very
specific
number
on
how
what
proportion
of
those
people
are
from
Philadelphia
and
what
portion
are
not
but
I.
Think
90%
is.
E
F
E
G
To
two
responses,
one
is
certainly
that
what
we
do
know
is
that
for
anyone
who
is
funded
via
Medicaid,
their
county
of
origin
actually
pays
their
expenses.
So
even
if
we
had
someone
coming
from
surrounding
County,
but
they
are
enrolled
in
that
County's
Medicaid
program,
that
would
actually
be
the
fund.
That
would
be
the
payer
for
their
services.
G
So
that's
one
I,
think
the
as
it
pertains
to
the
other
piece
is
that
we
actually
also
have
within
our
department
of
single
county
authority
and
they
meet
regularly,
or
at
least
monthly,
with
the
other
single
county
authorities
in
the
surrounding
counties,
and
this
is
part
of
an
ongoing
agenda
item
where
they
talk
about.
You
know
how
we
can
help
an
individual
who
may
have
come
and
again.
G
B
E
B
We
would
be
interested
in
any
anything
that
limits
their
ability
to
be
more
public
in
their
meetings,
providing
minutes.
Okay,
like
setting
all
of
those
types
of
things,
if
there's
any
issues,
maybe
confidentiality
issues
that
we
should
be
aware
of,
and
as
we
try
to
get
a
more
open
discussion
about
how.
E
B
Other
question
we
talked
about
when
you
were
in
your
previous
role
was
the
issue
of
really
looking
at
the
conformance
of
contracts
and
compliance
as
it
relates
to
it.
One
of
the
areas
as
you
and
I
were
working
on
procurement
reform.
There
was
a
concern
about
the
lag
time
between
the
beginning
of
fiscal
year
and
when
actually
organizations
had
conformed
contracts,
yeah.
B
E
This,
the
audit
of
behavioral
health,
is
focused
on
the
providers
performance
in
terms
of
outcomes,
positive
outcomes
and
making
sure
that
the
money
is
going
to
the
right
places.
The
issue
of
the
providers
not
getting
paid
in
a
timely
manner
is
a
is
a
serious
issue.
I,
don't
know
where
the
admit
the
kennedy
administration
is
on
that
now,
but
a
year
or
so
ago
it
was
definitely
a
big
issue
and
one
that
involves
more
than
just
the
Department
of
Behavioral
Health,
but
across
law
department
and
other
departments
as
well.
E
But
that
is
something
that
I
could
refresh
it's
something
that
the
city
needs
to
get
better
at
I
mean
the
providers
waiting.
You
know,
120
days
after
services
provided
to
get
paid.
Those
types
of
instances
are
just
not
okay,
so
that
is
something
that
I
would
be
happy
to
dust
off
and
look
into
okay.
Well,.
B
Thank
you.
We
we're
definitely
interested
again.
Is
there,
you
know
it
not
only
it's
bad
practice
right,
but
are
there?
Are
we
losing
money
because
we're
contracting
people
on
a
letter
of
commitment
and
then,
as
we've
reconciled
budgets?
Are
we
paying
more
for
stuff
than
we
should
be?
Have
we
been
clear
and
transparent
about
provider
services
from
day?
One
and
to
me,
is
you
know,
are,
is?
Are
we
losing
money
in
that
because.
B
B
B
What
are
the
beds
that
we
currently
have
in
the
system,
how
they're
being
utilized
and
and
particularly
for
David,
you've
some
clarity,
because
I
think
there's
Mis
misinterpretation
when
you
say
25%
of
our
services
are
available
at
any
given
time,
there's
an
assumption
that
there
are
2,500
25%
of
our
beds
available.
Let's
talk
about
who
are
the
beds
in
the
system
who
pays
for
them
and
if,
in
fact,
we
know
that
pathways
to
housing
is
working.
B
If
it's,
in
fact,
even
the
proposal
that
has
been
presented
and
I
think
it's
2.2
million
dollars
in
this
budget
year
and
even
mentioned
20
million
dollars
over
the
next
five
years,
is
that
enough
I
mean?
Are
we
really
just
setting
ourselves
in
this?
We
talked
about
program
performance-based
budgeting.
If
we
know
there's
a
need,
how
much
are
these
beds
costing
us
and
what
is
it
going
to
take
so
that
we
can
get
the
200
people
who
have
a
homeless
issue
in
addition
to
an
addiction
issue
in
these
encampments
into
some
of
these
beds?.
H
We
have
in
the
homeless
system
about
3,500
emergency
housing
beds.
The
system
runs
at
about
from
somewhere
between
90
and
120
percent
of
occupancy
at
any
given
time,
and
what
that
means
is
that
when
all
of
the
beds
are
filled,
then
there's
a
certain
number
of
people
who,
on
any
given
night,
may
be
sitting
up
in
chairs.
We
have
how.
H
H
B
H
Is
the
these
are
the
resources
that
we
have
what
we
did
and
we
read
readily
agree
that
it's
not
enough.
The
what
we've
also
been
trying
to
do
is
not
end
up
with
a
massive
shelter
system,
because
a
shelter
is
it
can
become
a
dead
end
for
people.
What
we
real
they're,
really
the
solution
to
homelessness,
is
a
house
or
an
apartment
or
a
place
where
people
can
live
with
the
opioid
crisis.
H
H
They
may
be
able
to
work,
and
you
know
they
don't
need
our
system
except
on
a
short-term
basis,
and
then
there
are
other
people
who,
if,
as
David
said,
have
a
serious
mental
illness
and
an
addiction
they
may
always
need
some
support,
so
the
pathways
units
cost
the
system,
a
housing,
housing,
permanent,
supportive
housing
costs
about
$15,000,
a
unit,
that's
a
rent,
subsidy
and
then
medicaid
pays
another
chunk
of
change
and
it
varies
depending
on
the
suite
of
services.
So.
H
The
rent,
that's
whatever
it
costs
to
administer,
sign
up
police
inspect
the
unit.
If
there's
repairs
that
are
needed,
you
know
it
varies.
Some
of
those
subsidies
may
be
lower,
but
the
regulations
that
guide
that
are
based
on
the
HUD
regulations,
where
we
pay
a
landlord,
a
fair
market
rent
and
that's
regionally
determined.
We
don't
expect
that
a
private
market
housing
provider
actually
takes
a
loss
because
they
house
one
of
their
people.
So
it's
a
fairly
expensive
service.
H
One
of
the
things
that's
happened
is,
for
example,
pathways.
They
have
60
units
that
are
funded
by
the
federal
government,
but
with
all
the
budget
cuts
over
the
years,
the
federal
partnership
has
shrunk.
So
last
year
we
at
or
this
current
year
we've
added
about
a
hundred
units
by
you
know,
adding
through
the
budget
and
by
reallocating
resources.
H
Sixty
to
seventy-five,
but
then
we
added
permanent,
it's
called
the
generic
area,
is
called
permanent,
supportive
housing
and
it's
a
rent
subsidy
for
people
who
don't
have
enough
money
to
pay
a
market
rent
together
with
a
suite
of
social
services
that
follow
them
and
that's
largely
funded
by
Medicaid,
assuming
their
Medicaid
eligible
and
the
services
are
medically
necessary.
So
permanent,
supportive
housing
is
the
evidence-based
practice,
has
about
a
90%
success
rate
in
preventing
a
return
to
homelessness
within
our
system
as
a
whole.
H
H
That
costs
ten
thousand
five
hundred
dollars
per
unit
on
average,
and
then
this
year
we've
been
piloting
what
we
call
shallow
rent-
and
this
has
been
a
partnership
with
DBH
IDs
and
us,
where
we're
working
with
30
landlords
and
we're
paying
them.
We
pay
them
six
hundred
dollars
a
month
and
the
individual
pays
200.
H
So
many
of
the
people
who
were
on
the
street
actually
have
an
income
they're
getting
money
from
SSI
or
SSDI
they're
permanently
disabled,
and
that
gives
them
about
700
or
$800
a
month,
plus
food
stamps,
so
the
most
they
can
afford
and
rent
is
$200,
and
that's
one
reason
that
they're
either
in
a
shelter
on
the
streets.
They
can't
pay
the
rent.
So
we've
been
doing
this
we've
been
piloting
the
shallow
rent,
which
is
about
half
the
price
of
a
regular
rent
subsidy.
So
with
this
we
have
landlords
who
would
like
to
do
more.
B
H
H
And
they're
individuals
who
have
come
out
of
DBH
programs
or
shelters
who
have
to
have
a
source
of
income,
but
they
can't
afford
a
market
rent.
So
we're
piloting
that
to
see
if
there
are
other
ways
that
we
can
expand,
that
with
that's
costly.
So
the
goal
is
that
you,
everybody
is
a
little
bit
different
and
our
system
is
trying
to
provide
the
lightest
touch
possible.
We
don't
want
to
over
serve
people,
but
we
try
not
to
under
serve
them
within
the
resources.
H
Now
I'll
just
say
one
more
thing,
since
you
asked
about
the
demand,
we
did
hire
a
national
consultant
through
a
competitive
process
to
assess
the
number
of
units
that
are
needed,
and
the
system
assessment
reveals
that
we
need
would
need
about
2,000
permanent
supportive
housing
units
in
order
to
really
address
the
need
in
the
city.
So
that
doesn't
mean
that
every
person
living
in
poverty.
H
C
H
B
H
Barrier
means
we
make
it.
We
try
to
make
it
as
easy
as
possible
for
people
to
come
in.
So
in
the
old
days
you
had
to
group
that
you
were
deserving
of
assistance.
That
was
the
way
we
worked
right.
So
those
you
know
30
years
ago
we
didn't
know
better.
What
can
you
say?
We
made
mistakes,
but
nowadays
the
idea
is
you
just
come
in
mm-hmm.
You
know
you
don't
have
to
show
ID.
H
H
H
B
Right,
no,
no
and
I
want
to
get
to
the
cost
of,
because
there's,
if
we're,
if
we're
going
to
go
back
to
the
core
of,
why
we're
here
around
the
coordination
of
how
do
we
break
down
these
encampments
and
deal
with
the
homelessness
of
folks
that
alone
the
treatment
services?
How
much
are
those
beds
costing
us
and
how
many
are
we
going
to
expand
to
to
be
able
to
get
ultimately
to
do
away
with
the
encampments
whether
you
use
the
San
Francisco
model
on
another
model,
so.
H
The
budget
proposal
on
the
table
is
to
add
a
hundred
and
forty
beds
over
the
course
of
the
next
year.
80
of
those
would
be
respite
beds
that
Street
into
a
low
barrier
respite
based
on
the
model
that
we
currently
have
with
prevention
points.
So
two
additional
sites,
40
beds
each
and
then
add
approximately
60
supportive
housing
units,
some
of
which
would
be
housing
first,
others
of
which
would
be
permanent,
supportive
housing
that
people
move
into
afterwards.
Now.
B
The
estimate
is
that
there's
120
people
right
now
in
those
encampments,
so
we're
sure
we're
looking
at
140
over
the
course
of
the
next
year.
So
you
know
we're
it's
not
enough.
How
much
so
we
still
don't
know
how
many
of
the?
How
much
is
this
costing
us
David
I
know
you
were
trying
to
get
a
number
for
us
Oh.
H
B
And
I
think
what
we're
trying
to
get
is
an
idea-
and
this
is
part
of
the
challenge
right,
because
even
those
of
us
who
try
to
be
in
the
weeds
of
this,
not
because
we
want
to
put
because
we
need
to
be
what
is
the
most
effective
low
barrier
low
costing.
And
what
are
we
doing
to
support
that?
That's
working
right,
that's
working
because
I
think
one
of
the
things
is,
we
all
agree.
B
H
B
H
One
person
it
depends:
it's
usually
averages
between
a
thousand
and
eleven
hundred
dollars
and
it's
guided
by
the
fair
market
rent.
So
it
depends
what
some
of
them
are
less.
We
certainly
try
to
do
less
and
generally
we
exceed
those
goals,
but
we,
you
know,
try
to.
We
try
to
be
conservative
in
our
estimates
and
then
and
and
then
exceed
those
goals.
Can
you.
B
Provide
for
the
chair
where
these
beds
are
currently
located,
as
it
relates
to
the
system
citywide,
because
one
of
the
things
we've
also
heard
at
community
meetings
that
has
been
a
little
bit
concerning
is
the
beds
are
not
where
people
are
and
people
you
know
or
that
whole
discussion.
So
where
do
you
feel
the
beds
are
equally
distributed
around?
Where
the
need
is.
H
We
think
I
did
that
analysis
based
on
your
suggestion
and
within
Kensington
the
emergency
housing
bits
Kensington
is
underserved,
so
the
only
respite
that
exists
there
right
now
is
the
prevention
point
respite.
Our
goal
is
to
open
that
second
respite
as
soon
as
we
can
and
then
the
third
in
the
general
area,
which
would
then
give
us
a
hundred
and
twenty
emergency
beds.
The
the
longer-term
beds
are
based
on
where
the
apartments
are
available.
H
It's
really
up
to
the
individual,
where
they
can
find
a
place
where
we
find
a
landlord
where
it
meets
housing,
quality
standards,
unless
the
only
exception
would
be
if
it's
an
affordable
housing
development.
You
know
Frances
House
of
peace
or
one
of
project
home
or
Bethesda's
or
Catholic
social
services
developments.
So.
G
Couple
responses,
one:
is
that
the
the
issue,
generally
speaking
with
the
low
barrier
housing,
is
that
that's
all
for
the
most
part
kind
of
temporary
housing
right.
So
it's
I
think
it's
only
going
to
get.
You
I
think
it's
maybe
about
six
months
or
so
average
lengths
to
stay
joh
a
little
bit
longer
safe
haven.
The
per
diem
for
safe
haven
is
about
$85.
The
per
diem
for
journey
of
hope
is
about
$300
and
so
at.
Are
they
correct.
B
B
B
G
So
what
we
think
about
it
in
terms
of
to
the
extent
that
you
know
how
having
someone
house
and
stabilized
as
part
of
the
treatment
right,
but
if
it's
so
again,
this
is
the
this
is
the
argument
that
we
make
around
physical
health
so
that,
if
you
went
in
and
you
had
diabetes
or
you
had
asthma
right,
you
may
get
some.
You
may
get
a
longer
hospital
stay
to
treat
that,
but
you
wouldn't
necessarily
then
get
permanent
supportive
housing
as
a
as
a
component
that
are
ongoing.
G
That's
why
I
was
saying
that
the
issue
here
is
that
so
once
treatment
is
completed,
this
the
the
ongoing
housing
issue
in
terms
of
a
social
determinant
of
how
of
health
continues
to
be
in
play
right.
So
that's
why
I
think
part
of
what
we
have
to
try
to
do
is
figure
out.
Then
you
know
again
in
terms
of
those
housing
vouchers
and
when
they're
available,
that
that
becomes
a
something
that
folks
dinner
able
to
could
be
connected
on
to
on
an
ongoing
or
so
journey.
G
H
B
C
Can
I
just
add
a
one
piece
before
we
address
that
question,
which
is:
we've
also
had
a
significant
change
in
terms
of
the
number
of
units
and
vouchers
that
are
available
from
the
Housing
Authority
in
the
last
several
years.
That's
due
to
several
factors
and
we've
been
working
closely
with
PHA,
but
I
think
it
would
be
remiss
not
to
add
that
into
this
conversation
there
had
been
a
fairly
long
term
agreement
in
which
up
to
500
units
and
vouchers
would
be
available
each
year
and
they
just
have
not
been
due
to
reduction
in
resources
there.
C
So
that
was
our
pathway
for
permanent
supportive
housing
for
quite
a
number
of
years,
and
now
we're
developing
new
ways
to
provide
permanent,
supportive
housing
without
those
resources,
and
it's
been
a
significant
challenge
and
it's
it's
one
that
were
adjusting
by
evolving
some
of
these
services.
I
think
that's
important
to
say
here
so.
H
H
Why
we
don't
want
to
expand
the
shelter
system?
People
say
you
know,
we
need
way
more
shelter
beds,
but
what
we're
trying
to
do
is
balance
it
out
to
be
to
put
the
money
into
housing.
The
difference
is
that
a
shelter
bed
may
turn
over
three
or
four
times
in
a
year,
whereas
once
somebody's
permanently
housed,
then
or
even
temporarily,
housed
that
subsidy
has
to
go
for
the
whole
year.
So
it's
not
a
one-for-one
replacement.
So
that's
the
balancing
act
that
we're
trying
to
find.
D
H
And
I
agree
with
you
and
I
think
one
of
the
frustrations
that
we're
facing
is
I
think
we
all
agree
that
housing
having
a
place
to
live
is
a
social
determinant
of
your
ability
to
be
healthy,
to
work,
to
do
well
in
school
to
sustain
a
recovery,
and
it's
really
impossible
to
do
that
from
the
street.
But
we
don't
we're
having
to
largely
provide
those
resources
ourselves
at
this
point
in
time,
I.
B
Guess,
I'm
very
frustrated
in
that
we
have
a
hundred
and
twenty
people
approximately
in
need
of
some
low
barrier
housing
to
get
them
off
and
and
again
you
know,
I
hate
to
sound
like
a
broken
record,
but
I
will
sing
and
dance
by
myself
if
I
have
to
cuz,
nobody
seems
to
be
listening
if
it's
$40,
if
it's
$40
per
day
for
us
to
create
this
low
barrier
situation
and
we're
only
planning
a
hundred
and
forty
beds.
How
are
we
ever
going
to
catch
up?
B
Well,
I
mean
I.
Just
and
I
want
to
get
to
this.
You
know
the
this
encampment
situation.
If
we
don't
tackle
it
now,
it
will
become
spring
in
summer.
It
will
get
normalized
and
it's
gonna
be
harder.
People
are
more
willing
to
come
in
in
the
cold
than
they
will
be
in
the
summer,
so
I
just
I
feel
like
we.
If
we
know
all
of
this
I
think
we
have
enough
stakeholders,
many
were
here
online
to
testify
to
tell
us
about
some
of
the
great
things
that
they're
doing
why.
B
C
C
H
H
It's
absolutely
not
okay,
it's
you
know,
in
my
view,
the
fact
that
we
have
nine
hundred
and
fifty
people
who
are
essentially
sleeping
and
living
on
the
streets
of
Philadelphia,
day-in
day-out.
Nothing
about
that
situation
is
okay,
I!
Think!
That's.
Why
we're
here
trying
to
figure
out
what
to
do
nothing?
It's
outrageous
that
there's
almost
a
million
people
across
this
country
who
are
sleeping
and
outside
when
we
have
these
vast
resources,
there's
nothing
about
it.
That's
okay!.
H
Absolutely
not
at
the
same
time
you
know
we're
doing
what
we
can
and
it's
frustrating
you
know
finding
a
site.
You
know
the
community.
You
know
this
very
as
well
as
I
do
Councilwoman
as
many
people,
as
would
line
up
and
say
we
need
more
beds.
There
are
gonna,
be
that
many
who
line
up
and
say
you
know,
put
him
out
at
48,
then
market,
which
is
what
they
told
me
when
I
went
to
one
community
and
I
said
they
said.
H
What
are
you
gonna
do
about
the
encampments
I
said:
I
have
the
money
to
open
a
respite,
what
I
need
a
site
and
they
said
how
about
forty
third
and
market.
So
yeah
I
mean
it's
a
it's
a
you
know
it's
one
of
those
things.
That's
complicated
that
we're
trying
to
resolve.
We
have
one
site
that
you
know
every
day,
I
think
we're
closer
to
signing
the
lease
Kate.
You
know
impact
is
here
today
we
have
another
site
that
we're
working
on.
B
Okay
and
and
again
I,
don't
want
to
take
up
because
I
know
we
have
a
bunch
of
folks
who
are
gonna
talk
a
little
bit
around
some
of
the
stuff
that
that
is
working,
I,
just
I.
Just
think
that
you
know
we
knew
when
we
were
gonna
clean
up,
Kearney
Street,
that
we
were
going
to
bring
to
the
light
something
that
everybody
knew
was
there,
which
was
at
any
given
time
anywhere
between
75
and
150
people
needing
housing,
let
alone
the
treatment
for
addiction
and
I
just
feel
like
there's.
B
We
have
enough
partners
in
the
room
in
this
room
alone
that
we
should
not
have
anybody
in
an
encampment
and
I
think
that
we
just
sent
a
horrible
message
that
this
is
okay
in
that
particular
neighborhood.
And
while
we
sit
here
and
look
through
all
this
bureaucracy
as
sigh
I,
just
I
just
think
we're
not
moving
quick
enough
around
this
stuff
and
even
in
our
budget
proposal,
putting
2.2
million
dollars
is
not
going
to
be
enough.
B
It's
not
going
to
be
enough
and
and
I
think,
as
we
get
closer
to
this
budget
discussion.
We
that's
why
it's
important
to
really
understand
this
whole
service
model
that
we
have
and
looking
at
what
are
the
other
ways
that
we
can
better
treat
folks
in
a
more
efficient
way,
and
it's
hard
for
me
to
tell
folks
we
don't
have
money
when
I
see
all
this
money.
B
I
know
we
have
another
hearing
and
I'm
going
to
apologize,
because
it's
mainly
my
fault
for
asking
all
the
questions,
but
if
the
count
of
the
chairwoman
wouldn't
would
indulge
us
for
folks
who
are
here
to
testify,
if
some
of
the
folks
will
voluntarily
allow
us
to
hear
your
testimony
in
the
community
session,
that
would
be
extremely
helpful.
So
we
can
at
least
get
through
panel
to
I
know
some
folks
have
written
testimony
as
the
cat
is.
B
C
C
A
A
So
what
we're
going
to
do
is,
unfortunately,
we
are
going
to
have
to
adjourn
for
the
time
being
until
the
next
hearing,
which
is
going
to
be
on
April
4
2018
from
5:30
to
7:30
p.m.
at
court,
no
Bevilaqua
Center,
26:46,
Kensington
Avenue
we're
going
to
keep
going,
though
I
don't
want
folks
to
feel
discouraged.
I
really
do
apologize
that
we're
not
able
to
hear
from
everyone
today,
but
clearly.
A
This
is
something
that
needs
to
be
thoroughly
discussed
and
vetted
and
we're
going
to
continue
the
conversation,
and
so
there's
no
more
conversation
to
be
had
so
and
so
and
so
for
the
next
hearing
we
are
going
to
have
everyone
in
the
order
in
which
you
were
scheduled
to
testify.
You
will
be
testifying
in
that
order
at
the
next
hearing
on
April
4th,
so
I
just
really
want
to
thank
everyone
for
being
here,
and
you
know
this
committee
is
adjourned.