Committee Hearing, May 16, 2025

COUNCIL OF THE CITY OF PHILADELPHIA SPECIAL COMMITTEE ON KENSINGTON Room 400, City Hall Philadelphia, Pennsylvania 19106 Friday, May 16, 2025 12:50 p.m. PRESENT: COUNCILWOMAN QUETCY M. LOZADA, CHAIR COUNCILMAN CURTIS JONES, JR., VICE-CHAIR COUNCILWOMAN NINA AHMAD COUNCILMAN MICHAEL DRISCOLL COUNCILMAN JIM HARRITY

240760 - - -

The hearing is now called to order. I'd like to also recognize that Councilmember Mark Squilla has joined us. Thank you for joining us in today's hearing of the Special Committee of Kensington. Our focus today is to observe and examine the best practices in substance use disorder outreach, a topic that is not only urgent but foundational to our response to the crisis we are facing in Kensington and in the Harrowgate community as well as across the city. Our research is essential. It is often the first point of contact for people living unhoused and struggling with substance use disorder. Outreach workers are the bridge between crisis and care. They are the ones meeting people where they are both physically and emotionally, to build trust and put them on the path towards recovery. This hearing will give Council and the general public the opportunity to hear directly from subject matter experts and on-the- ground providers who are doing this lifesaving work every day. Their insight and lived experiences are crucial as we work to understand what's working, where the gaps remain and how we can better support those on the front line. This committee is grateful to all of today's testifiers who took time to be with us and for sharing the expertise. We look forward to thoughtful solutions and this conversation. Are there other members of the committee that would like to make opening remarks? (No response.)

Will the Clerk please read the title of Resolution 240760.

Yes, Madam Chair. Authorizing the Special Committee on Kensington to convene and explore best practices in substance use disorder outreach and to investigate the effectiveness of current methods used by the City of Philadelphia and its partners.

Will the Clerk please call the panel we have to testify this morning on Bill No. or Resolution 18 No. 240760.

Madam Chair, we have Amanda David, Interim Deputy Commissioner for DBHIDS; also to answer questions accompanied by David Holloman, Chief of Staff Office of Homeless Services; Francis Healy, Deputy Commissioner of Philadelphia Police Department; and Isabel McDevitt, Executive Director Community Wellness and Recovery. (Witnesses approached witness table.)

Good morning. Thank you for joining us this morning and for your work, your consistent partnership. Please state your name for the record and begin with your testimony.

Good afternoon. My name is Amanda David. I am the Interim Deputy Commissioner at DBHIDS.

Thank you.

Good afternoon, Chair Quetcy Lozada and members of the Special Committee on Kensington. I am Amanda David, Interim Deputy Commissioner and Director of Behavioral Health for the Department of Behavioral Health and Intellectual Disability Services. Joining me today are Todd Nickelsburg, Single County Authority Administrator and Nicole Fries, Behavioral Health Administrator. And later on, you will hear from Lawrence Jackson, case manager with our Mobile Outreach and Recovery Services. Thank you for the opportunity to provide updates on resources and supportive outreach initiatives offered to individuals with substance use disorder in the Kensington area to address considerations outlined in Resolution No. 240760, introduced by the Chair. This resolution calls for an exploration of best practices in substance use disorder outreach to investigate the effectiveness of current methods used by the City of Philadelphia and its partners. Today I will provide an update on our outreach efforts. DBHIDS provides several resources to support individuals experiencing substance use disorder. Some of our key initiatives include DBHIDS Homeless Outreach, Mobile Outreach and Recovery Services, also called MORS, the Warm Handoff program through the emergency departments, wound care vans in partnership with Kensington Hospital and the Community Wellness Engagement Unit. DBHIDS homeless outreach: DBHIDS, through its special initiatives team, contracts with a network of organizations to provide homeless outreach to the city of Philadelphia. The DBHIDS homeless outreach teams are coordinated through PROJECT Home's Outreach Coordination Center or the OCC. The OCC manages the homeless outreach hotline and dispatches teams for response calls according to zones and proximity. The main goals of the outreach teams are to engage individuals, build rapport and connect individuals to services. During a response call, an outreach worker engages an individual and offers connections to resources such as housing, treatment, physical health care and other resources as needed. Each team is also responsible for engagement in the zone assigned. If a team is not engaging in a response call, the teams do zone work which includes engaging individuals that they come across walking through each of the areas where they're assigned. The network of DBHIDS homeless outreach teams represents over 50 staff members, consisting of two-person teams, and an 6 outreach team is available for 7 response 24 hours per day, 7 days a 8 week. Existing data shows that 9 individuals who have more contacts 10 with an outreach team have higher 11 rates of placement. 12 For example, individuals 13 who have had one contact with 14 outreach have a 17% placement rate, 15 whereas individuals who have had 16 five-plus contacts have a 46% 17 placement rate. 18 DBHIDS mobile outreach 19 and recovery services: The MORS 20 team provides on-the-ground support 21 for individuals experiencing 22 substance use disorder through 23 screening and referrals to 24 treatment. The MORS team is able to complete a substance use disorder screening and is able to make direct referrals to treatment from the street. The current staffing complement consists of five teams of two when we are fully staffed. Over the last year the MORS team has added a case management unit to provide continuity of care and warm handoffs to the next level of support. MORS has made over 1500 engagements over the past year. Wound Care: The Kensington Hospital Wound Care Outreach Initiative was launched in response to the increasing need for wound assessment and treatment in the community. There are currently two vans providing wound care in Kensington and across the city for xylazine related wounds and other substance use-related medical concerns. The mobile van not only provides wound care but some primary care and warm handoffs to other services as needed.

Warm handoffs in the hospitals: Hospitals in Philadelphia screen individuals for substance use disorder and facilitate warm handoffs to treatment and other resources using certified recovery specialists. These efforts aim to improve engagement and treatment, reduce overdose risks and provide comprehensive support for individuals struggling with substance use disorder. The Community Wellness Engagement Unit: The aim of the Community Wellness Engagement Unit is to provide greater access to behavioral health and wellness- related resources as well as linkages to care at a community level. The team offers peer support, behavioral health linkages, Narcan training and trauma awareness programs. CWEU teams are assigned to engage and support communities across all Philadelphia's City 8 Councilmanic Districts. DBHIDS 9 also has multiple partnerships with 10 our sister agencies that provide outreach to individuals in the Kensington area and around the city. Those partnerships include, but are not limited to, the Office of Homeless Services, Encampment Resolution Team, the Fire Department's Alternative Response Units and the Office of Public Safety's PAD program. In conclusion, our outreach framework aims to reduce barriers to care, increase access to treatment and support long-term recovery for individuals in Kensington and throughout the city through multiple interventions using a strengths-based approach. The City's approach to outreach directly impacts thousands of individuals offering lifesaving interventions, promoting recovery and reducing the risks associated with substance use disorder. DBHIDS remains committed to ensuring all Philadelphians have access to critical behavioral health and substance use supports. The staff members who are part of the various outreach teams are dedicated, compassionate and want the best outcomes for each individual they touch. They don't view this as a job but as a calling that aligns with DBHIDS's mission to educate, strengthen and serve individuals and communities so that all Philadelphians can thrive. While our existing efforts have made a significant difference, the need continues to grow. The Kensington area in particular faces unprecedented challenges, requiring expanded resources, sustained funding and increased outreach capacity to effectively address the crisis of substance use and mental health challenges in Philadelphia. Our recommendations for outreach best practices include creating a varied approach that includes multiple touch points for individuals on the street, ensuring an accessible care system that has low-barrier placement opportunities, including peer specialists and individuals with lived experiences as an integral part of the outreach team, ensuring a comprehensive, interdisciplinary, coordinated outreach approach so that teams can collaborate, partner and refer to one another and to provide case consultations to address challenging cases. Thank you for the opportunity to work with you today. My colleagues and I are available to answer any questions.

Thank you for joining us. Thank you for your testimony. I guess I have several questions. And we met a year ago -- we met about a year ago. And so, I'd like for you to share with us what are some of the changes that you all put in place over the course of the last year to change how outreach is done in Kensington that also supported quality of life? We've heard and we've discussed at length from residents how some of this outreach work impacts some of the children in our community and how it impacts some of the seniors in our community. And so, can you share with us a little bit about how and what you all have done to make sure that while we're connecting individuals with the necessary services through outreach or through the outreach process, how have you worked towards ensuring that communities quality of life has also been responded to?

Yes. So if we hear complaints from community members, we will definitely address those. One of the things that we also -- I think our response call system is one of the best ways that we support the community. If an individual comes across a space or a number of individuals who are --

Everybody's phone is getting an emergency.

If a community resident comes across an individual who is experiencing homelessness and/or substance use disorder, they can call the DBHIDS homeless outreach hotline through the OCC, the 215-232-1984 phone number, and we will send a response team out there to engage the individual. We have also added the continuity of care team with the MORS team. And so, what that team's responsibility is once MORS has done an engagement and a placement with an individual or a connection to a service, they do follow up with those individuals to try to make those placements and those services stick for the individual. Sometimes an individual may go into a housing placement and it may not be the best fit for them and they wind back out on the street. What the MORS case management team does is says, hey, you know what happened there, maybe we can reconnect you or maybe we can connect you to another place where maybe we can try some other kind of intervention that will work for you. The other thing that we have done is we have listened to the community concerns and all of our outreach teams respond. The homeless outreach teams are never stationary. They are mobile. They go to where people are and engage and leave, engage, connect and leave. And then with the other services that we have that are a little bit more stationary, they're mobile services but they're a little bit more stationary, like the Kensington Hospital Wound Care Van, we would work with the community and the community partners to make sure that the locations are acceptable for folks. So right now we have the Kensington Hospital Wound Care Van, which is outside of The Rock to serve individuals during the Tuesday Wellness Fair. And so, if we hear concerns about a space where one of our teams are, then we will definitely work with those teams to move them and to find a place that makes the most sense for the community and for service.

We passed legislation recently to require mobile providers to work in a coordinated process, and that is because we've heard from community residents that all of these things, the hotline, connecting with the different departments, all of those things weren't working for them, right. I'm hopeful that in the next 60 days when we start this coordinated effort that we are going to see a shift in how outreach and mobile service providers operate in at least in the 7th Council District at the moment. And I say that because I want to be sure that folks understand that it's not about eliminating services, but coordinating it in a way that would respond to both community needs as well as those needs of the individual that is receiving those services. How do you all currently measure a successful outreach, right? I think you mentioned that after five touches or engagements, that is considered a successful -- I guess a successful opera -- or whatever, a process. Five times could have a huge impact, a huge negative impact on a child who's witnessing all of these things happening in the community, a community in general, a business. So how do you guys measure that? Does it have to take you five times? Are we looking at this in a way that wouldn't require us to have to do so many engagements in order to be able to respond to the person's needs as well as protecting quality of life?

Yeah. I think that -- so I want to first say that I think that we have the same goals. I think that the City has the same goals as the Caucus, right. And so, we want to make sure that people receive the services they need, but also we want to be responsive to the community and make sure that the community has what they need too because we're not just responsible for the people who are on the street, but we are responsible for the entire Philadelphia, you know. And so, all of our services, we have services that run a myriad. We have from soup to nuts. We have services across the span. A successful engagement, we obviously think results in placement, right. But a successful engagement could also be that this person is now willing to talk to us, right. So every time that we talk with an individual there is a greater opportunity for them to access care or access supports. So it could be that on the first try we have a conversation with somebody and they're going to accept treatment or placement or something to come in off of the street. Some folks it could take a longer period of time. We ask pretty detailed questions. It's hard for people to trust people in general. Like I think that if somebody came up to me and said, what's your name, what's your date of birth, what drugs are you using, what's going on here, I would be like, whoa, you know --

A successful engagement, right, which to me is challenging, right. I could be Maria today. I could be Joanne tomorrow. I could be Paula the next day. And so, I'm just trying to understand what's a successful engagement if every time you come and communicate with me I can give you a different name and that's the information that the outreach worker is going to put on their paperwork?

Yeah. You could give us a different name every time and we still know who you are. So our outreach team, we have lots of folks here who are part of the outreach teams. They know these folks. They engage -- especially the ones who are willing to engage and have conversations with us. They know by where they go, where they hang out, what they're wearing, how they interact with one another. And then we also communicate within the teams and refer to each other like, oh, hey, I'm really having a difficulty reaching so-and-so that sits at this place. And then we'll kind of work with the other teams that are out, do you have a good relationship with them, do you have a good -- what's the best next step for them. And we really do try to target our engagements to each person.

Thank you. The Chair recognizes Vice-Chair Curtis Jones.

Thank you so much, Madam Chair. And if I heard you correctly, the five times of touch and engagement what I heard was that it increases the probability of getting somebody in; is that for the record correct?

That is correct.

Okay. I thought I heard that. What I want to ask is on a weekly, monthly, quarterly basis how many touches do you have? And out of those touches, how do they result in -- so I was talking to Member Squilla about the wound treatment you mentioned. So is that considered a successful touch? When you wrap that person's wound, they don't go in, they don't treatment but they want to go about their daily routine. How do you categorize that touch?

So you're correct in your assumption that if you have five or more touches, there's a higher percentage of those folks who go in. But at every touch, at every touch point, there's a possibility that the person could go in and we have percentages related to that. We would count that as a positive connection and a successful engagement because that individual then was willing to engage in some level of intervention for whatever's happening with them.

So I guess where I'm going with this is give me a monthly number that we had last month -

Of engagements?

Per person how many individual touches, how many multiple touches and what did the result -- do you have a what-is-it-called, dashboard --

A dashboard.

-- of that kind of -- so that we can kind of understand -- look, and understand when we're listening, we ain't judging. Some of us might be but I'm not. We are listening and we understand you are building a plane at the same time you're trying to fly it so we don't expect the Wright brothers to get it right the first time. But what we need to know is what is the universe and how is it treated, how's it counted? And what are your success outcomes per month?

So I don't have the data with me right now that speaks to that very specific question, but we can certainly pull the data and send that to you so that we can show what that looks like.

So that's everything to this committee and our Chairperson because we then can argue the point of success but also maybe we need to tweak it a little bit to say this or that, but without that data we can't have good information. So that's an essential part of your --

Yes.

Second part of this is where are you -- and if you choose not to answer it, I respect that -- but if there's more of a move now that these contacts can result in involuntary commitment to programs. And this is a sincere question. Sometimes I ask gotcha questions. This is not it. This is sincerely where you stand on this and whether that is the kind of direction we should encourage the administration to go in and say, you know what, after the fourth touch and we're treating the same, maybe we need to do something more aggressive, where are you on that?

So there is legislation at the state right now. I read an article just yesterday about there's legislation that's up at the state and we're continuing to track that. And as soon as there's an outcome for that, we will be working with the administration once the outcome is known about how it will move forward.

So you know I'm a politician, we're politicians up here. Are you for it or you're not or you're still thinking about it? I'll give you those three.

I'm sorry. Say that again.

Either you're for this type of continuum of contact and then at some point an involuntary commitment or you're not for it or you're still thinking about it and gathering data? Take one of the three.

Yeah, I don't have an opinion on it right now. I think that things remain to be seen. And so, as we learn more I'll probably form an opinion, but my official opinion is that I don't necessarily have one right now.

So now, if you were advising us and the state where's the threshold that you would say, you know what, they might be a danger to themselves and others. So if somebody -- and I come across this in our travels, all of us do, somebody's talking to themselves. That's not a threat to themselves or others. Now, somebody's throwing things at people. How do we develop a line that says you know what, we're going to make you sit down for a minute and maybe stabilize your meds or whatever that is. Are you preparing thresholds that you might offer to us or the state to say here's when we should intervene?

So the Mental Health Procedures Act outlines very specific items related to what is considered the threshold for a mental health crisis. We will work with the Administration to figure out what that would look like for substance use disorder if this bill passes, and in that work with, you know.

But at some point you're going to tell us where you are on this, right?

I think that we -- I want to follow up on what the Councilmember is saying. Because I think that I've always said we need to look at this differently, right. We have allowed this to progress to the point to where we are right now. We have a crisis in Kensington. We have a citywide problem, but we have a crisis in Kensington. We've allowed an entire community to deteriorate. At what point do we start looking at this from the perspective of every time that person is going to inject themselves that is a suicide attempt, right? That is an attempt for them to potentially take their lives. Because we know that the product in Kensington continues to change and it continues to get deadlier. So at what point do we start saying this person understands that there are deadly doses of heroin, fentanyl in this community, in this footprint, in a footprint where I spend hours a 14 day, 760 -- 365 days of the year, 7 15 days a week, right? At what point 16 do we start looking at it from that 17 perspective? 18 I hear from a lot of 19 professionals and they say they're 20 making themselves numb from a 21 situation or an experience or a 22 trauma, right. So if we're looking 23 at it from they need to use in 24 order to forget the trauma they've experienced, then is it applied for help every time they're injecting themselves? And I'm asking. I don't know. I'm asking and I guess I'll ask others who come up here the same question. And is that a reason for us to start thinking about does involuntary treatment have to be considered at some point and do we wait those five-plus engagement times in order to determine whether this person should be brought in involuntary or not? We have people losing their body parts in front of people's homes, right. Their body parts are falling off because they're not responding to them. So at what point do we allow them to continue to live that way. We know they can't make decisions for themselves. And so, at what point when is somebody going to say we need to change how we do this?

So I think that what we would have to look at what other states are doing and how they're implementing some of these same things and I think that we could have a conversation about that. I'm prepared to talk about outreach.

I think that's part of the outreach, right. This is a part of the conversation of outreach because to Member's point here, five engagements will increase the probability of them accepting treatment. But as a government, we need to assume the responsibility to understand that this individual's body is rotting from the inside out and we need to determine after the second engagement that that person's body limb is in horrible condition and it is this close from falling off and/or them losing their lives. And so, when does outreach say, yeah, we can't continue to wait. This person is in dire need of further medical attention?

She's not going to answer today.

(Inaudible).

Yeah, I mean I think that --

And again, that's not a gotcha question. I want to be real clear. I want to have an honest conversation here. I don't want you to think that you're in the hot seat, right. I really want it to be a part of a conversation, but I think that we need to start thinking about that, right.

Yes. And I know that the intention of these questions is to serve people and to treat people with dignity and respect and to get people off of the street and to help them preserve their limbs and their full body and their mental state and all of those things. I understand where these questions are coming from. And I would be happy to be a part of something where we can talk about this and what it could look like moving forward. I don't have an answer for you today, but I'm willing to be a part of the conversation.

Thank you. The Chair recognizes Dr. Nina Ahmad.

All right. My colleagues are really patient. Are we enabling this process is what the question is. This is not just a year-old problem. Department of Behavioral Health and Intellectual Disabilities has been dealing with this for years. And for us to sit here and say that we haven't thought of alternatives, we haven't looked at best practices, we haven't come up with the plan is really irresponsible. It's really irresponsible for one of the biggest departments -- biggest funding segments of our budget is health. And as the Chair of the Public Health and Human Services Committee, I am disappointed that we are not being proactive, we are not being bold, we are not taking the lead. We don't have to wait for other people. We can do our own due diligence. We can do the own research. We can figure out the own best practices and we can come up with a plan. For you to sit here and say you are not willing to answer that is really disappointing. As long as we've had these resources and we continue to do the same thing every day and not say aha, where's the light bulb moment, why are we continuing to doing the same thing and the problem is not resolving, should we be doing something different. And, you know, government is CYA. And I don't know if that's what's operating here for us not to be bold and innovative to really help people, both those who have substance disorder and those who are living surrounding these folks and unable to leave. It is deeply responsible for our government and every department involved in this not to have part of alternative ways to deal with it or not be prepared to discuss it to say, we tried this, didn't work, we tried this. I'm a scientist. Things don't work always. We cannot have the perfect system. We cannot let perfect be the enemy of good. We have to have some courage, which my colleague here has demonstrated in spades to -- she's the only one along with this committee who is asking these questions. And I can't, you know. I'm new to this Council so I am just appalled that it has been allowed to go this long and a community has been distressed this long. We know we have a drug control problem, the flow of things. We know that. We are working on some drug task force that is working silently and suddenly we hear some results. I'm assuming our law enforcement is working on that, but clearly we're not changing now. We have a new drug, which I saw on your website, Medetomidine, which does not respond to Narcan. It's mixed in. So it's just going to get worse and worse because these drug dealers are going to keep pushing this stuff. We know this. So what are we doing to be innovative, bold and discuss options and not sit here and say we're not going to answer these things? We're not going to be engaging our communities, our legislators here to say this is where we are. I've heard nothing about changing status quo that has been operating for the last few decades in this area. So this is not a question because you're clearly not answering it. But that is problematic. This is a hearing to come up with thoughts that we are solution-oriented. Aren't people watching? Our community members are watching, our constituents are watching us saying, what is the Department of Behavioral Health doing with so much of the budget if they're not coming up with innovative solutions. I can't wrap my head around this one. When we look at a problem, we look at all the parameters, we look at the variables. We see which ones we can control, see which ones we can and we work on those. And you have not told me anything except that you keep sending out troops to talk to people and engage them and then hope they change the way. We cannot let that happen anymore. We have to have a more constructive system where not only are we helping people with substance use disorder but also the community surrounding them.

So you can respond to this or not, but I just want to go on the record that this is unacceptable for our Health Department, our Behavioral Health Department, and also Public Health. I don't know if Public Health is here, but that we should be working in concert to understand what is going to be different so we can address this problem. We have taken gun violence and we have looked at it differently. We have poured money into grassroots organizations to make sure we touch people. We're using CBT. We're doing all kinds of innovative things. What have you seen? A reduction in gun violence. Is it perfect? No, but it has reduced. So we need that kind of -- as somebody said yesterday in our Council meeting, Councilmember Jay Young, the same approach of Vision Zero for no traffic deaths, we need to have that Vision Zero. Why are we not driven with this? Why are we not like thinking about it 24/7 to say, what can we do. I don't see that urgency. And I'm very disappointed to say that our city cannot be bold, innovative at the forefront of making change so that we can really save lives. Thank you, Madam Chair. That was just me being really disappointed.

Yeah. I'm really sorry that you're disappointed. And I would actually say that we have been bold in our approaches. Just because I didn't answer the question related to a 302 doesn't mean that we haven't changed our approach over the past number of years. When xylazine came on the scene, we were struggling with that. The drugs change so quickly in Philadelphia that we are always behind the eight ball because the drug dealers don't consult with us about what they're putting into the drugs. So we have to monitor how drugs are affecting people and then provide intervention related to that. So one of the things that we did when the xylazine crisis came in was we implemented the Kensington Hospital Wound Care Van and created a space in Level 4 treatment programs to be able to get people connected to treatment for their wounds that was specifically dedicated to that. Every time the drug chain --

Can I just interrupt. This is all after the fact. You are doing things that after the wound has happened, after this new drug has come in. I am trying to ask what are we being proactive, how are we being proactive about this drug use to stop it to even begin with? What are those issues -- what are those solutions? Where have you worked on that? What you're doing now is cleaning up the wound basically.

So what we have done to prevent drug substance use disorder is we have prevention programming in the schools. We have early intervention programs where people who are at risk for substance use disorder can be enrolled. We have programs like the Warm Handoff program that if somebody comes in and they're substance-using, then they will have those conversations and connections to care. We have --

So all of these things has resulted in data?

Can I finish? Can I finish?

I just want to say you're going to tell me all these things, but we need numbers. Like you did in one year, we did so many of these things and we have seen a reduction in substance use in Kensington and the city. Do we have outcomes based on interventions? Because that's why we do interventions to measure them and see how are they working.

Yeah, we will provide that to you.

Yes, please. Because then we could say you're being innovative, but you have not given us any information to say that we're being proactive knowing the problem and attacking it all different ways and these are the results of how we have structured this ability to stop this in the first place and do the wound care and all that needs to happen for those who we cannot get in the first, first round. But we need to have a comprehensive outline of all Step 1 through 5, what are we doing and what are the communities being impacted and what are the outcomes and how long has it been since we did it. Without that, you say you have the funding gap. How are we going to give money or ask or advocate for money if we don't know what the results are from what you've done in order to say this is working, which is what we've done with gun violence. We've seen gun violence programs working so we're asking for more resources. We're asking for more CBT training in these spaces because we've seen the results. We need this in this arena as well. Thank you.

Thank you, Councilmember. I just want to state for the record that there are currently 37 states that currently have involuntary commitment for substance abuse disorder. And so, as a committee I know that my team will be looking at what those states are doing. And I encourage all of us who are in this space to look at that, what does that look like, right. And how do we prepare our city to better respond to the crisis that we're seeing in Kensington. We've been talking about this now since I walked in the door November of 2022. Councilmember Squilla, Councilmember Sanchez have talked about it for years before I have arrived. And I think that again walking in the door I've been saying we need to do something different, right. We can't continue to allow for individuals to continue to die on our streets, right. Folks have to stop saying that as a result of what we are currently doing now as a Council or as a Special Committee that we're going to cause deaths because the data shows that deaths have continued to rise in that community because of how we've consistently done things. And so, I think that if we want to see a change we need to change how we're responding to it, right. And so, again I want to encourage all of us to start thinking about this maybe in a different way than we have currently been doing so in order for us to see a different response to what is happening on the ground. The Chair recognizes Councilmember Jimmy Harrity.

I have been following the cases so New York is one of the most prominent. When I was with Senator Street, we were waiting to see what happened with the court cases that were going on in New York because this isn't something that's new. We've been thinking about how do you do something like this for a long time. So I'm going to have to go back and look at if New York has a ruling yet. Because if the state is looking at something, I would imagine that they got something favorable. But other than that, I'd like to know the MORS outreach people, right, what color vests do they wear?

Yellow.

Yellow vests. So they're out there, they're the ones with the yellow vest. And you're saying 1500 engagements in the last year. Okay. How many are you now saying -- how many people are you now saying are still out on the streets of Kensington? What is that number?

So I don't have that number specifically. But over the last year we made 346 connections to care, treatment placements and housing placements.

300 --

346.

346 treatment and housing?

Yeah. And so, the engagements are not an unduplicated count. It could be multiple engagements with one person.

That's what I'm getting at. You caught it. So you're saying you've taken 346 people off the streets of Kensington. Is that what you're saying? 346 that have gone to treatment or housing. That's what you just said, right?

Yes. So citywide, that's a citywide number.

So that's a citywide number?

Yes. 346 citywide to treatment or housing. Again, I will ask what is the number of unhoused addicted currently living on the streets of Kensington? That is the number that you guys should know. That's your bread and butter. So what is that number? I mean, you're here to testify. This is what actually frustrates us because we feel, all right -- well, you know what, I'll speak for myself. I feel that when you guys come in front of us you have a lack of respect of being prepared. When we come here, we are prepared to ask you questions. We expect you to be prepared to answer those questions on the spot, not get back to me with a number that you should be able to rattle off your head. So again, do we know the number? I see notes being passed around.

So OHS provided -- OHS did the last count in January. OHS will have those numbers. We did a count two days ago. Those numbers are not fully aggregated yet. It'll take about two weeks to pull those numbers together to get the most updated information. What I can say is that in the fall we had a 36% decrease in the number of individuals in Kensington.

We had -- say that again.

We had a 36% decrease in the number of people in Kensington from fall 2023 to fall 2024.

36%. Okay. So out of the 1500 engagements you have -- so the 346, they are successful completions of the treatment program?

They are successful placements where they got to the programs, got to programs and to housing.

Okay. So this number is not real at all right here because you're saying -- this isn't 346 people that you have -- you have just put them in contact with treatment and housing. These 346 aren't currently completed a program. The 346, that's just people that you've connected, not actual people that have completed anything or do you know the number of those 346 people, how many of them completed the program? How many of them are currently still in the program? How many people have left that program? These are simple numbers. I mean, nobody here is trying to blame anybody. This was a complete whirlwind. You know, I'm in recovery. I know what it is out there. I live in Kensington. I live at G & Allegheny. I'm fully aware. I deal with it every day on a daily basis. So nobody's trying to say that you guys aren't trying, that you guys don't care. That's not where we're trying to get to. We're just trying to get to the base of this thing where we can figure out how do we continue to do the things that work, get rid of the things that aren't working, including the groups who are charged with doing this work. Because I don't know about anybody else, but personally again, I live there so I drive there every day. I leave, I go right down Allegheny Avenue different times of the day. So it's not -- when I first seen it, I thought, well, maybe it's the beginning of the day, this is where I'm going to be, you go over here, you go over there. But it seems that whenever I drive by there I do see them out there with their yellow vests all standing there talking to each other. And as I said, at first I thought that was because maybe they were doing a morning meeting or something. But it seems they tend to gravitate to themselves while there are and 30 people 7 sitting around. Now, they may have 8 touched them. I don't know. I 9 don't know what the deal is. 10 That's what we're trying to find 11 out, what the real numbers are. 12 So you'll get me some 13 numbers for that real 346 of what 14 that actual number is of people 15 that are in a program or finished a 16 program or for that matter are in 17 housing right now because that's 18 the bottom line? For me it's about 19 mental health, housing after they 20 get the initial sobriety.

Thank you, Councilmember. Of that 346 I'd also like to know how many of them were in that Kensington community, right. You said 346 was a citywide number. How many are in the crisis footprint? The Chair recognizes Councilmember Squilla.

Thank you, Madam Chair. We've been looking at a lot of different ways and different situations of how to handle both the opioid epidemic and the new trail of drugs that now the people on the street are using. As we were working with the heroin and the fentanyl crisis and now you saw the xylazine and the Medetomidine and the challenges even with the new thing that's coming in, it's almost like a paint thinner that they're doing that it's putting like plastics into their bodies and it's poisoning them from the inside out. So some of the old things that we've been doing and even challenges that we had on the street to look at how do we get people even to detox them have changed. And now, there's new working with the tranq and other ways and we see that some people are using ketamine and some other things to try to detox individuals. Are we actively looking at the new substances that are now on the street looking at some of the things that we did in the past and maybe try to alter that as we try to work with the population that's there now and trying to get them -- because what I'm hearing from some of the people in the street is a lot of them are afraid to go to rehab now because a lot of the old ways that best practices that we were using doesn't work and they're afraid that they're going to have a really violent reaction.

Yes. So we are working with organizations like Penn Medicine and the other hospitals in the area to determine what the best practices are for the withdrawal syndromes that individuals are presenting with in order to head those off as early as possible so that folks can remain in treatment, in care and actually, progress through the treatment system. So we are working with them. The Health Department does the drug checking program, so they're the ones that find out when there are new adulterants in the drugs. And so, we work with them as well to figure those things out.

But as you see these and working with them, understanding that we're going to see a trend where people are not going to want to go through detox because of some of the symptoms that we're not actively being able to address because some of these have to be done in a hospital setting, right. And so, we have that challenge and folks that are trying to do it on the street are sometimes not doing it properly, right. And so, we have to make sure that we are getting that information to these other individuals that are providing services and things like that. Because if not, we're going to see an even larger spike in overdoses and things. And I mean, it's a challenge. And I know other areas -- it seems like Philadelphia seems to come across these before other areas do so we have to try to figure it out and make it easier for them. But we still have to work I guess like you're saying with our medical professionals and come up with a system so when our providers are out there, everybody's doing the same thing. And the other one was a mention about a dashboard that we have that for all the open available providers that we use. Is that readily available to everyone so that we have a dashboard if we need a 4.0, if we need a 3.7, 3.5, does everybody have access to a dashboard so they can know what's available, we could send somebody and get them in immediately because we know that the time is of essence and if they're ready to go, you got to get them in now?

Yeah. So we do have the treatment availability database that's on the DBHIDS website and we can send you the link to see that. We are working on an RFP. I mentioned in the budget hearings we're working on an RFP to get a bed registry system in place. And so, the RFP is due to be released by the end of the summer I believe. And so, that will be more like what, Councilmember Lozada, what you have been thinking about and talking about related to that.

And will that be accessible by all the people who are on the street who have permits to be out there helping and do things, all the outreach, everybody will have that information?

So they will have access to the treatment availability database. That's public on the DBHIDS website.

All right. But the availability, to get somebody into a bed immediately, right. So if you have three beds open, they know that they have three beds in 3.7, say, or 4.0 and then they know exactly, you could call, boom, and we have access to that and, boom, they go in. You're saying that will be ready by the summer?

By the end of the summer, the RFP will be ready by the end of the summer to RFP for the build-out. So we're going to have to work with each of the different treatment providers to make sure that the beds are accounted for, that the systems work with one another. It can be a complicated rollout, right. But we are actively working on an -- the RFP should be released by the end of the summer. And then we'll update you guys about what the actual rollout plan will be because we have to work with the vendor --

But why do we have to wait until the end of the summer to put an RFP out? We're going to wait until -- are you saying it's too complicated to put an RFP together to have people bid on this?

No, we're working on the -- so we wanted to have conversations with all of the stakeholders that are involved that will be entering information into the bed registry system and then we have to write the RFP and then the RFP will be posted soon.

Because I know we had -- when we had a meeting with ERP and they had something similar that they had put together, did you guys look at that at all as a model to see if maybe an RFP could be modeled after something that they already have set up?

Is ERP the folks that presented at the last one? We did meet with them and we've had to do some research to make sure that we were putting all of the important things into the RFP.

I think the goal for us is to make sure that that outreach worker that is out there is equipped with everything. They should be able to open up a tablet, a phone and say this provider is ready to accept this person right now. If it's at 12 o'clock at night, o'clock in the morning, 6 o'clock a.m., 5 o'clock in the afternoon, this provider has X number of beds, right. This provider can take a DV victim. I think what we're asking for is trying to figure out how we make that outreach worker's life I guess on the street much easier to be able to connect this individual. If they're talking to someone and that individual says, well, I want to come in but, that outreach worker should be able to put that but into that tablet or into that system and be able to say, well, we have that too and we can connect you right now, right. I think the goal for us as a committee is to figure out how we work towards minimizing the number of engagements so that we can connect that person or, yeah, through outreach with whatever services they're putting on as the but, right.

Yeah.

So I think that that's what we're looking for. The Chair recognizes Councilmember Harrity.

So say we have a successful touch, right, where the person says I'm ready, right. Explain to me what that looks like. How long from when they say they're ready to we can have them placed? An hour, two hours, what's that time frame look like?

So if an outreach worker engages somebody and they're ready to go to treatment or to housing, the time frame can vary. So to housing, we usually know that the spot is available and we take them directly to the housing. As soon as the person can get into the van and we can drive to the housing placement, then we can do that.

So we're taking people who have not completed a program directly to housing instead of treatment?

Yes. Some people, yes. Some people that's what they're willing to accept at that point. And so, in those lower barrier facilities we work with the individual to begin to think about the ways that treatment could help them. And then a lot of times those individuals go for treatment the next --

Where are you then putting those people? Are they in the same kind of housing that the people who are coming out of treatment are going to?

No. 21

Okay.

No, no. And then if there's an individual who's interested in going into treatment, if the MORS team is engaging them, they can do the assessment on the street and they can take them to the -- they can secure a bed for them at a location. It could take about an hour to two hours if they have to be evaluated because of some other kind of physical health complication. It can take a little bit longer because they have to be seen by a physical health professional to get that challenge cleared so that the person is safe in order to move into the treatment setting. So that would be things like if a woman is pregnant or has a gaping wound or something along those lines.

And what about the detox medicine? Will they be able within that hour to two because that's, you know, give them something to take the edge off will keep them there longer, you know what I mean. It gives them a little bit more patience than when the jones is setting in and the body just can't control itself. So when they're intake within this hour to two hour time period before they go, the wounds can be -- well, if they have to go to the hospital, that's a little bit longer, right. That's understandable. But barring no wounds and they're able to go directly in within that hour or two, they'll be given their Suboxone or whatever it is, methadone or whatever we're treating it, that's a whole other thing to get into, but within that hour or two so that we can get them?

So once they get to the provider, they'll get assessed and then the provider will work with the individual to determine what's the best course of treatment for them and medications will be prescribed by the physician that's there to assist that individual. So I would say --

We are taking care of the fact of keeping them level and keeled that way we --

(Nodded affirmatively).

All right. Just trying to make it a point that people have been saying that, you know, people are in these places suffering because they're not getting meds and stuff like that, you know what I'm saying. But from what you're saying is that you guys can pretty much once they're willing to accept it, they go into the thing, they see the intake nurse and they'll assess them and, bam, they get their meds, they keep them level while they're, waiting to be transported, correct?

Not while they're waiting --

Because what I'm trying to get at is trying to figure out -- we're hearing about people abscondering, being sent into the program they accept, and then they get a block away or something and jump out of the car. The ones I heard about were PAD I believe because AMP is actually through the courts so it's a little bit different. And that's kind of one of the other things we're trying to get at, the difference between PAD and AMP and how they're both used as two tools in the toolbox but with the goal of getting them in. But I'm just trying to make sure that people understand, because we've taken a lot of heat about, oh, you guys are killing people, you're making people go to this thing and they're not ready and they're going through the DTs and all that stuff while they're there. And I just wanted to make sure that we got on the record that that's not what happens. They are taken and when they're ready, they're given the meds to get them through that stuff, right, to keep them so that we're not losing them in between?

So they will receive the medication at the treatment provider. The outreach teams and the MORS team are not prescribers so they can't give medication out. But when they get to the treatment provider and get assessed and have that conversation with the treatment provider, then the treatment provider is the one who can prescribe --

We need to streamline that process. I'm telling you you'll have more people. If we can get them the meds while you're sitting there waiting, you'll have more people stay. They'll be calm enough, they'll be able to at least have a little bit of less of a fog to make decisions, not only to make decisions but to get through that. I'm not heartless. I know it's rough. I mean, these poor people go through it. And I think the quicker that we give them their what they need to get them to be able to get to the next step will help us have more of them succeed in that process. Because if they're -- I was there. It's rough, man. When you're sitting there thinking, that's the only thing you can think about is what's going on, your body starts going nuts and that feeling and that's it, you got to go. So the more we can do to ease that right when they're ready, right when they're going, we need to get them the meds ASAP. When they say I'm ready to go meds, then we get them in that bed. Maybe we need to look at how we do this and the policies. And listen, we're not naive. We know this stuff takes money. But to be honest with you, we're throwing up a lot of money here. We're not scared of that. We want to help these people, but we want to make sure that money is being spent in a way that people succeed. And as somebody who speaks from my learned, lived experience, I'm telling you now that the more we can do to get these people that little extra help right off the bat will also help us get them over the finish line. And that's really what it's about, right. It's getting them over that finish line.

Absolutely. Thank you.

And listen, thank you for what you guys do. We know that you guys do a lot with a little, but this is your chance. We really want to know what we have to do to get this situation under control. That's it.

On that note, can you share with us -- when you hear from your outreach workers, can you share with us what are they telling you are there challenges? What do they say, these are the challenges that we're experiencing on the street when we're coming in contact with those who are living in substance abuse disorder? And how have you all responded to what that outreach worker is telling you is their biggest challenge?

So I think that the outreach workers generally say that we need low barrier placements for individuals. And so, places to take folks when they are not necessarily willing to go to treatment but willing to come inside, and then that's when conversations can happen to motivate people more toward treatment. So the Philly Home at Girard has been a game changer for us, the Mayor's initiative with that. That opened up 180 beds. That really made a big difference for us. People are clamoring to get in there. And so, that is always low barrier placements. A lot of times people just need to come in, eat something, be treated with respect, take a shower, sleep for a little bit. Because when you're in that constant survival mode, you're not able to necessarily think about being hopeful for recovery. You're not necessarily thinking about what treatment means or those types of things. You're worried about being safe and where am I going to eat next or what do those things look like. So low barrier places to take people is really the key with the goal of every intervention and every engagement that we have is really to inspire hope with folks and to begin to get them to think about what the next step in their recovery is. And so, those are the types of things that are successful on the behavioral health side and can make a big impact and can make a big impact and show a big impact quickly.

And I appreciate you saying that, right, because I think that what people fail to understand is that that coordinated space that we've identified in partnership with the Administration, that will bring people into a space where they can receive all of those services that you just said, a shower, a bathroom, a food provider, a clothing provider, a wound care provider. People that all are certified and understand and know what this person could potentially need in a space that will provide them that dignity and that compassion I think is important, right, which is why I think that we need to look at the Mayor's model in that type of space, right. The goal is to allow them to know I can go to that space and I'm going to find all of these services all in one location where I'm not going to be judged, right. Speaking of that space, in order to get into that space you have to have come in contact with the police department, right. How is the police department working in collaboration with the outreach workers that are on the ground? I know that we heard at one point -- and Deputy Commissioner Healy may be probably the best prepared to answer this, but we heard that the police department partnering with outreach workers or with mental health workers would better maybe help with the communication of those that are living on the street. Can you tell us how has that worked? What are some of those challenges and are we still seeing the challenges that an outreach worker experiences without public safety support? Does it work better or does it work better when the public safety official is partnered with that outreach worker?

And I would love to have -- I think that multiple approaches work. So for one person, an engagement with just an outreach worker will be successful. In other situations, it might be an engagement alongside of a police officer or because the police officer took them to the PAD office. DEPUTY COMMISSIONER HEALY: First for the record, Fran Healy, Deputy Commissioner, Philadelphia Police Department, and thank you for allowing me to talk. The issue of whether or not -- we call them the CIRT team, the Crisis Incidence Response Teams is an add-on to our CIT model, which we've had since 2007. The teaming up between the police officer and the mental health clinician has been incredibly successful. I have with me the sergeant from the behavioral health unit that can talk more into details, but the notion of the work that goes into that it's not one size fits all. Like I said, our CIT officers, we have more CIT officers in Philadelphia than any other city by percentage. We have well over 88% of our first responder CIT train on average 25% is in most cities. So that's a good thing. We have right people responding. But the issue is some of these cases take time. The officers often times just don't have the time. That's why the CIT or the CIRT teams are incredibly useful. Everything slows down. The officer is there for safety and security, but they often step back out and allow the worker to go in there and it gives that worker the sense of security to do what they need to do. I don't know if you can say one's better than the other. It's kind of like a quiver where we have a whole lot of tools -- or toolbox I should say. There's a lot of tools in the toolbox that's been incredibly successful. We have data that the sergeant can come and tell you the data we have. But the issue is we're actually -- the important part with the CIRT program is not only the initial encounter, it's the follow- up encounters. So we are connecting after the fact when people are not necessarily in crisis. So you can actually then often times get through that barrier, through that shell. So the ability to communicate with individuals often times when they're in immediate crisis. And when I say crisis, please don't take that as the wrong thing. Every human being in this room has been in crisis. It's a matter of you can't handle what's happening at that moment in time, drugs, alcohol. It could be a loss of a parent. It doesn't really make a difference. How the officer interacts is what's the key. The issue is making sure that we get through that egg shell that we engage them and actually make that connection. So the CIRT teams have been incredibly successful in doing that. And the number of contacts they had and the number of follow- ups I don't have them with me, but my sergeant does. The Behavioral Health Unit became prepared with everything that we possibly could have.

Thank you for that. Amanda mentioned earlier that the number of unsheltered residents has decreased by 36% and that the numbers and the recent count was done recently but not available. You all, the police department, counts more often from what I understand than sometimes OHS and DBHIDS. Can you tell us where we are in the number of unsheltered people living on the streets of Kensington and when was the last time the PD counted? DEPUTY COMMISSIONER HEALY: Actually I'm happy to say that -- Deputy Commissioner Rosario, you have that? DEPUTY COMMISSIONER ROSARIO: Yes. DEPUTY COMMISSIONER HEALY: He has these numbers routinely and that's why I'd like to introduce Deputy Commissioner Rosario for the Kensington initiative. He'll have those numbers for you.

What was that? I'm sorry. I didn't hear you. DEPUTY COMMISSIONER HEALY: Deputy Commissioner Rosario.

thank you. (Witnesses approached witness table.)

Please state your name for the record. DEPUTY COMMISSIONER ROSARIO: Pedro Rosario, Deputy Commissioner of the Kensington Initiative for the Philadelphia Police Department.

Thank you for being with us today. DEPUTY COMMISSIONER ROSARIO: Good afternoon, Councilwoman.

So my question was Amanda mentioned earlier in her testimony that they recently did a count. The numbers are not available of those that are living on the streets of Kensington unsheltered. I am under the understanding that the police department counts more often than the other two departments. I'm going to add another piece to my question now that you're sitting there. But my question originally was when was the last time that the police department counted? What are the current numbers of those who are living unsheltered on our streets in a 12-month period? Give me that for right now and then I'm going to -- DEPUTY COMMISSIONER ROSARIO: Okay. So the East Service detail, which is run by Sergeant Michael Hanuscin, is responsible for the co-responder model. That may have already been discussed about prior to my arrival. They work collaboratively with all of our outreach, our city outreach workers from DBHIDS, homeless outreach, and they're constantly working with CLIP in that footprint of the Kensington Initiative. But they also provide a complete service to the entire police division, East Police Division of the 24th to 25th and 26th Districts. Obviously, a lot of our focus is along that Kensington Avenue. So Sergeant Hanuscin and his people do two counts a week. Recently we just modified the one of those counts to try to coincide with Wellness Court on Wednesdays. So the sergeant directs his overnight personnel Tuesday night into Wednesday morning to do a count. We just started. I think this was the first week that we started it. But in order to gauge some of the some of the feedback we've been getting from the community, that the numbers are dropping on days that they know Wellness Court is going to be in operation. So we just started that process this week, but we do two counts a week to answer your question.

And have the numbers gone up or down over the course of the last year? DEPUTY COMMISSIONER ROSARIO: This week it's 368. And if we do a comparison year-to-date, it's over 400. So we were at 412 this time last year and we're at 368 this year.

And how is your count, the police department's count, how does it differ from the Department of DBHIDS and OHS? DEPUTY COMMISSIONER ROSARIO: If you want, ma'am, I can have the sergeant, he can come here and give you the operational portion. That way you have it in detail. I'll have Sergeant Michael Hanuscin come and speak to that.

Thank you. Please state your name for the record.

Michael Hanuscin, Police Sergeant Philadelphia.

My question to Deputy Commissioner Rosario was how does the count that the police department the two times a week, how does that differ from the numbers that DBHIDS does and the Office of Homeless Services, how is it different?

So, Councilmembers, I can only speak for our count. I'm not exactly sure how they do theirs. But for our account we have a predetermined list of locations that my officers are aware that unhoused individuals usually congregate at. So there's a list between all three districts in East Division, 24, and 26. 21 They at nighttime go to these 22 locations and they just mark down 23 rough estimate of the number of 24 individuals that are at that location at that time. Same applies to the day count. It's just done during different hours.

Do you all share information about the process that you all use to count some of our unsheltered residents? Do you share that process? Is there a list of requisites in order to count an individual as living unsheltered on our streets? For instance, I hear and I could be wrong, right, but this is what I hear, police count everyone that is out there within a specific period of time, right. OHS may only count them if they're laying on the ground. Somebody else counts them or doesn't count them if they're moving from one street to another. They could look like they're living unsheltered. They could be pushing a cart, but they're not counted because they're not stationary. So my question is how do we know and how is that list compiled? And do you share that with one another? Do you share those numbers at the end of the month, at the end of the quarter, and how do they compare? And does outreach help with that, right? Does the outreach workers help us with that? DEPUTY COMMISSIONER ROSARIO: Yes, I can tell you that those numbers are shared with Homeless Services and DBHIDS. We meet I want to say two times a week to discuss different various strategies. And the Sergeant's count is part of our distribution list with Amanda's team and Dave Holloman's team so we're constantly sharing that information. With regards to what we count as an unsheltered person to what their count is, the argument I can offer is just a lot of times the police are the only ones there working the overnight hours. So I think a lot of times, and not to take anything away from their process, when the officers are out there early morning, late night doing that count I always thought that was a little more or it's a little easier for us to grasp a truer number of people that are there, because obviously the folks that have a place to stay wouldn't normally be out there at that time, if that answers your question.

Yeah, thank you. I asked that question because I'm trying to figure out how do we determine how many outreach workers we are putting in a specific footprint, right? And do we have enough outreach workers for the number of individuals that are out there or do we need more in order for them to be able to connect with more individuals, right? Do we think that we need more outreach workers in that footprint? Do we think we have enough outreach workers in that footprint at the moment to be able to respond to the crisis that we have?

I think that we can always use more outreach workers. But with those outreach workers, we need resources in order to place folks. So it's not just necessarily increasing outreach workers, but increasing resources on the backend. We need an off ramp for folks. And so, as we increase outreach workers, we don't want them vying for the same number -- like, they'll be vying for the same number of beds. So as we're engaging more people and able to place more folks, we would need more spaces to place individuals. And again, that low barrier option is generally the best practice to get people directly off of the street and has the biggest impact to show to start and then helping move people through the system.

But then that would speak to us needing to be able to have the data to be able to respond to impact, right. So if we don't have the numbers and we can't track data, how are we then ensuring that the work that we are actually doing on the ground is effective, right? I think that's why there's frustration because we need to be able to have the data to be able to say, yes, they have the appropriate number of outreach workers, yes, we are responding to ensuring that the work of the outreach teams are responding not just to the person that's living in substance abuse disorder but is also conscious of the quality of life of those individuals that are there. Yes, teaming up police with outreach workers work or doesn't work. I know that we can't be the only people thinking about this, right. So is this information or are these questions that all of you who do the work every day are asking each other? Is there someone that they go to to say this is what we need to do and how are you responding to that? DEPUTY COMMISSIONER ROSARIO: So we've been having this discussion. And one of the strategies we've seen is to your point we don't want to duplicate a lot of effort understanding there's a lot of financial investment here by the city. So we're actually moving to the point where we're trying to make the Wellness Center at 265 East Lehigh our clearinghouse. And what I mean by that is similar to police operation we always try to de conflict whenever a different law enforcement agency is coming into our space to do a specific operation, so that way we're aware of where they're at and what's going on, what resources are they utilizing in that area. So that way the officers that are working in that vicinity know to stay away or to be able to provide some type of immediate support. So that's the same strategy we want to use for our purpose now, to be able to use the Wellness Center at 265 East Lehigh as a clearing center for us. So that way all of our teams would be able to check in, advise as to where and how they'll be operating and successes or failures that we've had in that vicinity. So I think it's a concerted effort because we understand the resources are limited and an effort to not duplicate the services that are being provided to that field. So that's our posture that we're moving into right now.

Thank you. Chair recognizes Dr. Nina Ahmad.

I just wanted to talk about the long- term treatment options, those you can bring in. And I wanted to understand the medically-assisted treatment that is currently being used. And you spoke about the different initiatives where you're doing outreach, you're getting people in, there's a warm handoff, what that tracking is and how many of them are continuing to receive treatment. You know, some people might need to be on treatment forever, right. So I just wanted your thoughts on that long-term process post taking folks in.

Yep. So the medication-assisted treatment that is provided through the Department of Behavioral Health is medication plus substance use disorder counseling at a DDAP-licensed facility, Department of Drug and Alcohol Program through the state. Medications that are provided or available to individuals include methadone, buprenorphine which is also known as Suboxone, Vivitrol and Sublocade in some of our locations. And so, all of our substance use disorder treatment programs have access to either have the medication or have access to getting somebody the medication that they are requesting. The licensing for methadone is a little bit more stringent so not all of our programs have methadone, but we're able to refer individuals who are interested in methadone to methadone. We do track individuals and outcomes for individuals who are in treatment and what they, you know, we look at the placement rates and the continued stays and those types of things. And we have that aggregated by actual program with CBH so that data is available --

So that is success that you can get them to the long-term treatment?

Yes. And so, one of the other things, Councilmember Harrity, that I failed to mention is that with the new mobile services bill we're excited to be able -- we have a mobile methadone van that's licensed and we are excited to be able to get that cited so we'll be working with your office. I know that Director Geer has been working with you. It's been a labor -- yeah, we were trying to get it over the hump, but we're really excited to be able to offer that because that will be able to provide that linkage for individuals who are wanting treatment.

So just to wrap this question --

I'm sorry. Again, the goal of that coordinated space is just that, right?

Yeah.

How do we identify a space where these individuals will know I can go there and I'm going to be able to get my MAT, I'm going to be able to get a shower, I'm going to get food, I'm going to get clothing, I'm going to get wound care and it's all going to be done in a way that is received by a person who knows what they are doing, right. It is a certified medical professional in that space that is going to take care of me and make sure that I'm receiving whatever the services are. And if I need further attention, then I'm going to be able to go across the street to a hospital that's going to respond to my more serious needs, right?

So it seems that that tracking that you do of those who get past the detox and the warm handoff to get the long-term support and treatment, to me that is the success story, right, when we can get to that point and when they exit. And once they exit the long-term recovery resources, are we continuing to track them because I know the Riverside model is about getting them job training, housing in addition to treatment, right? So I know it's very new. I just wondered what is the trajectory that we track past them leaving because we don't want them to circle back. We want them to stay in success. What does that look like? What are we doing for people who successfully do all of this and are recovered? And then how do we make sure they stay recovered because as we know this is a lifelong issue?

So we do work with individuals once they complete their treatment process in their bed-based recovery to connect them to housing either through the recovery house system to Riverview and to whatever, maybe back to family, those types of things. Some people never see us again. They don't want to be involved with our services. They're good. They move along. But for folks who stay within our system we continue to track and make warm handoffs to whatever levels of care. If they come back into our -- if they wind up needing to come back to bed-based treatment, we have conversations. We do continuing support planning to get them back to the next level. And it's a continuing conversation and relationship through our network of providers to keep folks together.

That is the number I would love to get, like how many people have graduated. I don't know if you -- obviously you have that number, right. And I don't know -- it's scattered. Different people are coming out of different spaces which is why the coordination is so important. But if you could share that number. You might have to go back and look for this, but we would love to say this is how many people in 2024 successfully exited these programs. And I don't mean that they're still in recovery, but at least they went through this entire process and we can say they are recovered. That is the number we can share with our constituents to say so many people came in, so many people were successful and this is what's happening. That's where the -- you mentioned hope. That's the hope we can circle back and tell people who are in the very first stage, look, X number of people if you do this, you will be like them. So many of them went through and are successful and now they're living on their own in their own homes and working. That's where hope comes from when we actually have success to share with them and encourage people who are in the very first stages to do that. So that's completing the loop. And I would like to get some data, Madam Chair, around that where we are with those people and how we're taking those stories back to -- especially with our outreach workers who should be having those stories to tell. Look, this is X person. This is what happened to them. This is what they're doing now. They have a job, they have a home, they are recovered. Let's share those stories. But we also need the numbers in order to say you need more outreach workers so let's have some more money for that. You need to make sure the mobile units have these resources when they're going. So I would love to get that Thank you.

Sure. And we'll go back. And our lovely data team is here. They've done amazing work and pulled numbers in different ways for us. And so, we'll go back and have a conversation about that. So thanks in advance. But we'll go back and have those conversations with them and try to pull some meaningful data for you.

Thanks. You should be touting those numbers, that our work is resulting in this and that encourages us to say all this back and forth is actually doing something. Even if it's a small number, it's still success. So I look forward to that. Thank you, Madam Chair.

We've heard from different residents multiple times that sometimes the way that outreach is done is disrespectful to the person who's living in substance abuse disorder. The police is disrespectful, outreach workers are disrespectful. What is the training that outreach workers receive? In order to be able to go do this really difficult work, right, how do you respond to community residents or stakeholders who say, hey, sometimes these outreach workers are too tough or not tough enough? How do we respond to that and what is the actual training that some of our outreach workers receive in order to be able to do this really difficult work?

Thank you. So a lot of our -- all of our outreach or I'm sorry, all of our outreach workers attend training at their provider agencies. It includes ride-alongs with experienced outreach workers to show the standard that we expect. There is an outreach training series in the summer and in the winter to talk about specific challenges that people can face when it's hot out and when it's cold out and what resources are available, what you could see out there. And then we also expect all of our provider agencies to be providing a list of trainings that include trauma-informed care. I don't have the list running in my head. I'm kind of blanking, but I can get you a list of all the trainings that we expect, but how to do a warm handoff, how to do a 302 petition for people, how to connect to linkages, what a warm handoff looks like and then just also a training about what resources are available. If there is a resident that is observing an outreach worker that is not being respectful of either them or they believe that it's not a respectful interaction between the outreach worker and the individual experiencing homelessness, we would ask them to contact either the Outreach Coordination Center or they can submit a complaint to DBHIDS and I actually have that number. It's 215-685-5458 or they can email dbhids.complaints@phila.gov and we will look into it. We would need specific information so that we can drill down about who the person was and where the interaction happened and that sort of thing. But we take quality very seriously and we don't want people treating people in a bad way, whether it's an individual that's receiving services or a community member. So those are the ways to get in touch with us if something is not happening the way that a person believes it should be.

And I asked the police department that same question, but wanted to ask you, Amanda, as the supplies change, as some of our unsheltered mental health changes due to the supply that's out there, is there continued training for some of our outreach workers to ensure their safety and the safety of those that they're responding to?

Yes. As we see changes in the drug supply and changes in the presentation of individuals, we all meet very regularly to talk about what's happening, what we're seeing, all of our teams are connected and teams outside of just outreach workers, so the MORS team, the PAD team. It is a very coordinated group of people. Everybody knows each other, everybody talks. And so, there is a lot of information that's relayed back and forth. When information rises to -- some of its stuff that can be passed off. If it rises to something that needs a training, then we will implement a training. Just recently I believe it was actually right before the Eagles won the Super Bowl we had a training for outreach workers about how the new drugs were presenting and how it's different. What used to happen was you would administer Narcan, the person would pop up and they'd be on their way. Now, it's different because there are more sedatives in the drugs and the response has to be different. You have to sit with a person for a little bit longer and they're not going to pop up. That doesn't necessarily mean that they need extra doses of Narcan. It could mean that they just need -- we need to call the Fire Department because their breathing is lower or something along those lines. So we do do those types of updates as we're seeing them and we share them far and wide. And then we also make sure that that information is captured in our summer and our winter trainings as a matter of course.

And before the police, if I may respond to that. Is that information or is that training also offered to other outreach workers, Office of Homeless Services and stakeholders?

Yes. We put the call out usually to our providers and to our internal city partners, but others are definitely welcome to attend, not the summer and winter trainings. External, non-city contracted. The summer and winter trainings are specifically for the DBHIDS outreach teams. We can certainly invite and we may invite the OHS workers. I don't control that list, but I'll follow up on that. But the external non-city connected folks are not invited to that.

Okay. I mean, I asked that question because to me the outreach worker is out there exposed in a difficult environment, right. And so, we want to make sure that there is a way for them to remain informed and educated and ready to respond to the change in that supply, right. And so, just asking the question about how you all cross-share information. I know that as a government we have a challenging time in talking to departments about what we're doing. And so, because our outreach workers are out there sometimes in spaces that are dangerous I want to make sure that there are processes in place that will ensure for them to remain safe as the supply continues to change, sometimes daily, right. So that's the reason I asked that question. So I'll ask the police department for your response on how do you respond to community residents that say the police department needs more training on how to respond when doing outreach work? Sometimes they're respectful, sometimes they're not, sometimes they're not tough enough and sometimes they're too tough. DEPUTY COMMISSIONER ROSARIO: Yeah, that's an easy question to answer. No, so obviously the police department first and foremost we're I guess out of the all of our city agencies we're probably the most forward with ease of being able to file a complaint against one of our officers. There's a multitude of ways that can be done. And I don't have to educate the Council regarding that. You all are familiar with it. But the other thing is one thing I want to bring to note to you is all the officers that work in the East Service Detail are volunteers, right. So these are all officers that want to be in this space. They understand this space. They're vetted by the Sergeant and then that list goes up to me to decide whether the officer has sufficient time in the field and to make sure that we do our own internal investigations regarding complaints, to make sure the officer would be adequate to fit that need. But every single officer in the East Service Detail is at the very minimum crisis intervention-trained. They also received supplemental training through our Law Department to make sure that we're following the rules and regulations regarding encampments and the proper treatment and offering of services with our unsheltered folks. But I really want to give a lot of credit to Sergeant Hanuscin and his team because they're really -- I mean, they work hand-in-hand with all of our city agencies and all of you sitting on the panel bore witness when we are at the community meetings of how much love and respect they get from our community because they're very fluid in response and very professional in how they treat these individuals. The officers, the district officers that respond to the normal 911 calls, you know, my fear is always that they get a little lazy because they depend on our service detail for a lot of that interaction. So we are always encouraging a more robust regarding all of our officers in the field, but Sergeant Hanuscin and the service detail are the resident experts in that space and they enjoy a great reputation with that community.

Thank you for that. Thank you. Chair recognizes Councilmember Jim Harrity.

Just curious, how many actual outreach workers are currently working in the 7th Councilmanic District? And out of them are there, is there anybody, supervisor or anything on the street who's actually a drug and alcohol counselor or somebody that actually can talk to them and relate to what they're going through? You know, peers are always great. But having somebody who is actually a professional that the boots-on-the-ground people can refer to in case they have something that's maybe a little different or maybe they think if somebody different might be able to actually talk to them to get them over that little hump, somebody that actually knows, what does that look like, what is the makeup of that? I know they get training. But the people in charge, what's their training?

So we have two special initiatives teams, one through DBHIDS, their DBHIDS employees and we have Project HOME special initiatives team that are both detailed to Kensington. The lead on the DBHIDS team is a Master's level social worker and then the other two workers have experience in doing outreach. So the Master's level social worker is the one that leads that team and sort of leads a lot of the work in Kensington. The --

I get it. Social workers are great, but they are not addiction people necessarily. It's different, you know what I'm saying. Social workers I have all the respect in the world for what they do with peanuts, but I want to know how many actual certified addiction specialists we have boots on the ground out there with the outreach workers? I don't expect the outreach workers to have those certifications. We just need them to care, right. But their bosses and the people that they report to should have that training. There should be some criteria for a job of that nature, you get what I'm trying to --

I hear what you're saying. I am not certain of the -- the job description does not require a certified addiction counselor. So what I'll have to do is I'll have to go back and look at each person who is a supervisor in those locations and I'll have to let you know what that is, what that looks like, but I hear what you're saying about that.

Okay. Thank you. Thank you, Councilwoman.

Are there additional questions for this panel from members of this committee? (No response.)

Thank you so much for being with us today. Will the Clerk please call the next panel.

Madam Chair, we have Dr. Jeanmarie Perrone and Director Nicole O'Donnell from the University of Pennsylvania. (Witnesses approached witness table.)

Good afternoon. Thank you for joining us today. State your name for the record and begin with your testimony.

Good afternoon. Dr. Jeanmarie Perrone. In addition to Nicole O'Donnell, Peer Recovery Specialist, we also have Diamond Stahl who is also a Peer Recovery Specialist and she's going to provide the testimony that you were submitted. I'm going to speak first. Good afternoon, Chairman Lozada and members of the City Council Special Committee on Kensington. Thank you for your work on behalf of the people of Philadelphia. My name is Jean Marie Perrone. I am a professor of Emergency Medicine and a Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Our center is a model center for opioid use disorder treatment at Penn Medicine. As an emergency medicine clinician and researcher, I've spent two decades preventing opioid addiction and optimizing access to treatment for patients with opioid use disorder, especially from our emergency departments and also enhancing primary care and in-hospital substance use treatment. We advocate for a peer- led medication model. And what we know, both from data and experience, is that outreach is not optional. It is essential. Philadelphia has one of the highest overdose death rates among major U.S. cities. But those numbers only tell part of the story. Behind every statistic is a person, many of whom are disconnected from care, unsure where to turn or distrustful of health care systems. In Philadelphia, our patients are not just challenged by fentanyl but by emerging adulterants, including xylazine associated wounds and severe fentanyl Medetomidine withdrawal, leading to overwhelming fears of treatment and an endless cycle of continued use. Outreach shifts that paradigm to meet people where they are, on sidewalks, in encampments, in shelters and in the emergency department. Outreach is more than handing out information. It's about building trust, offering harm reduction tools like Naloxone, xylazine and fentanyl test strips, reassuring patients about withdrawal management and creating a human connection that can lead to treatment, whether that's buprenorphine, methadone or long- term recovery support. In neighborhoods like Kensington and South Philadelphia, outreach workers in low barrier settings such as wound care or mobile vans are often the first and only point of contact for someone using opioids. At our center we've seen that individuals referred through outreach are more likely to engage in care and stay in treatment because their first encounter was grounded in respect and not judgment. Outreach is a clinical extension of care. It saves lives, reduces emergency visits and helps people stabilize, not just medically, but socially and psychologically. But for it to work, it needs sustained investment in personnel training, infrastructure and coordination. The opioid crisis cannot be solved from the emergency department or clinics. We must go to the people who need us most. That's the power of outreach, and it must be at the heart of Philadelphia's strategy moving forward. Thank you for taking the time to invest in this critically important issue. And I speak as a clinician, but I am so honored to work with people in recovery who have made that journey and who are the testimony to the success of outreach, and I'm happy to be joined by them today.

Thank you. Good afternoon, Chairwoman Lozada and members of the City Council Special Committee on Kensington. Thank you for your work on behalf of the people in Philadelphia. My name is Diamond Stahl and I am a Certified Recovery Specialist at the Center for Addiction Medicine and Policy at the University of Pennsylvania Health System. And I also work at Merakey PAD program, the Police-Assisted Diversion, and I am also the embedded peer in Kensington Wellness Court. As a peer in recovery, I work at the Center for Addiction Medicine and Policy, owning my lived experience to connect people to resources. One morning I encountered a young woman at our Kensington location. She was visibly shaken, yet she gradually disclosed that she was from out of state struggling with opiate use disorder and was seeking treatment options. We related through so many shared experiences. I explained how I once moved to Mississippi hoping I could outrun my addiction. During our conversation, she shared that she's been in Pennsylvania for four years without being connected to treatment, housing or any other services. Not once? It struck me how invisible her suffering had been in a city with so many resources. She told us about her partner, how they've been together for the last three years. They had nothing, she said, but they had each other. I felt her pain because I know how it feels to find home in a person and to tie your survival to theirs because it's the only anchor you've got. She might not have a roof over her head, but she has someone who relates to her. That is the power of connection. We offered to help her partner too because that meant helping her. Outreach is the beginning of building something valuable. It takes multiple engagements to capture what a person truly needs. I know we will cross paths again and when she's ready, she knows that there are people waiting to walk alongside of her. Her recovery is not linear. People do not heal on schedules that fit into data points or budget hearings. Many people we encounter are deeply traumatized, unhoused and physically unwell. Expecting immediate transformation is unrealistic, but every interaction, every act of care increases the chance that maybe something will click next time. Outreach and peer support saved my life. Being able to see someone that I have once used drugs with transform and make it to the other side inspired me so much. It planted a seed. I didn't get better the first time someone offered help. It took time and it took people who never gave up on me. That's what we do every Wednesday. We show up again and again and again because we know that trust takes time and healing doesn't happen on a schedule. I've learned in my own journey and through countless others that I don't get to decide when someone is ready for recovery. What we can do is keep showing up and remember that change is hard. We've seen people fall, disappear, come back, try again and eventually rise. Success shouldn't be measured by solely on treatment completion. It should be measured by the seeds we plant, the connections we make and the dignity we return and the small steps toward trust that often bloom into big steps towards healing. The young woman from out of state might not be on anyone's list of program completions, but she's a person who knows that she's not alone and that matters. That has to be the beginning of something. And when I say that outreach saved my life, I truly meant that. I was homeless in Kensington for over three years. I celebrated three years in recovery on April 15th this year. I -- (Applause.)

Thank you. I seen a guy in Kensington who I've used drugs with before. He disappeared, fell off the face of the earth for like nine months. I didn't see him. I didn't know what happened to him. And then one day in Kensington I seen these purple tents put up and I seen him under there giving out food and Narcan. And at this point I don't think I showered for like two weeks. I stunk. I looked really bad. I actually was showing them a picture earlier of what I looked like. It's the transformation you would never think, right. And he gave me a hug and gave me a sandwich and just made me feel love again inside. I felt cared for. And after multiple engagements with him, I finally reached out and was like, hey, I'm ready and I've been sober ever since. He helped me through the whole process. He helped me get through detox. He helped me go to the recovery house, helped me find funding for recovery housing. He helped me get through the whole entire situation. And I actually have the honor of working alongside him today. And we do this because we know in all of our heart that this is what truly has helped us. (Applause.)

Congratulations and thank you for your testimony.

Hi. I'm Nicole O'Donnell. Thanks for having us and there's nothing that I can really say that is going to be more impactful than Diamond's story other than I have the honor as being a person in recovery to work alongside with Dr. Perrone and Diamond and the person, his name's James, that helped Diamond get into recovery. So we have a staff of 4 peers that I get to watch every day 5 make an impact, whether it's in the 6 emergency department or in the 7 community doing outreach while 8 we're at the location at 265 9 Lehigh. Diamond and I were out 10 doing outreach last week on 11 Wednesday and ran into her brother. 12 And her brother's struggling and 13 it's very close to my heart that 14 story. I lost my sister to 15 overdose in 2014. So to see Diamond's brother and know that we can help him via outreach and he did. He came into 265 and he did get some support. And I think diamond has a really important text message that she wants to read from him that explains why outreach is so important.

So he texted me on Wednesday and said, thank you again for all of your help. It means the world to me. I'm truly sorry for letting you see me like this, but it's because of people like you that I still hold on to hope. I still believe that the program does and will work. If I decide to work it, I will get better. I promise. I love you.

That's amazing. I have so many questions for you all right now. I guess I would start with again I want to make sure that folks understand that we recognize the importance of outreach. We understand the importance of mobile services. We understand the importance of multiple interactions or engagements with individual people who are living in substance abuse disorder. If you were to say that or if you could share with us one or two ways that you could change how outreach is done that would allow for continuing to connect people with these much necessary services so that we have these continued success stories tenfold while protecting those who are living on our street in our community, what would those one, two, three things be, right, because we talk to young people often? You know, my coordinated mobile service providers bill came about as a result of multiple town halls with community residents as well as young children and seniors who have said, again, we are all for outreach happening on the street. We don't want or we can't continue to allow for outreach to happen at my doorstep because it impacts mentally and emotionally my children, my family, my quality of life. And so, if we had to respond to community residents and we want to say to them we want to continue to hear and provide real opportunities for young people like yours, what would those three recommendations be?

Well, I think if you take a look at my journey and the part that outreach played in my life, you could see that what stands out is that there was full wraparound support, full wraparound support. It started with one person and ended with one person. That one person stuck by my side the entire time. It wasn't five different people offering me five different routes. Sometimes that can get a little confusing. He stuck by my side and he made sure I got into treatment. And then after treatment, made sure I got into a recovery house. He did the whole thing and it wasn't really for any reason other than he knew who I was and he wanted to see me do well. I think I've been to treatment times, and I think 9 most of the time when I left 10 treatment and didn't have an 11 aftercare plan set up or couldn't 12 afford rent at a recovery house, I 13 gave up hope that it would work 14 before I even gave it a shot. So I 15 think having that full wraparound 16 definitely plays a huge part in it.

That's a great point, yeah. I think outreach with a purpose, like not leaving people there where they are. So I think making sure that we have the outreach workers have the resources to be able to respond to an ask for help that day is really important too.

But how do you respond to -- so that is important for the person who is living in substance abuse, right. But how do you respond to the resident that says, yes, I want this to continue to happen, we are ground zero in this community, we recognize -- and I talk to residents every day, right, and they want these services. They understand the need for these services, but it is impacting their families. It is impacting them directly. How do we better provide outreach and services without impacting the quality of life of the residents who can't just say I'm picking up and moving to the suburbs, I'm moving to another county because Philadelphia has not been able to respond to the crisis that they allowed to be created in my community?

I really applaud your concern for the community and I think this is really of critical importance to work together. A housing first model, you know, it takes many steps to get down that journey. Providing housing would solve this problem of people being unhoused, which is essentially the first problem along with the substance use, and then the use of long- acting injectable medications is tremendously helpful. So often we see people go into treatment, they do well for a week or two weeks or whatever short period of time. There's much journey left after that, but it can be incredibly augmented by an injection of a long-acting medication on the day of discharge or utilized in the setting that they're in. So it really takes away some of that early treatment ambivalence that can get people off course, and along with that certainly housing.

You mentioned in your testimony the CAM -- CAP --

CAMP.

Can you speak a little bit more about what that is and how it would help us respond to the situation in Kensington Harrowgate?

Yes, thank you. CAMP is the Center for Addiction Medicine and Policy. It was started about five years ago essentially to build a response to addiction in our Penn Medicine Health System. So what it really means is that we have an army of peer recovery specialists and substance use navigators who help people in primary care offices in the emergency during hospitalization. But we also augmented that, creating this telehealth safety net being able to provide buprenorphine via telehealth for people who have fallen out of care. You know about the X waiver a few years ago. That was the only way you could get buprenorphine was you had to have an X waiver provider. So Penn had a virtual urgent care that came out during the epidemic. And so, we trained those nurse-practitioners to be able to prescribe buprenorphine. So seven days a week 9:00 a.m. to 9:00 p.m. we have substance use navigators that answer the phone. They can answer phone calls about women's health, about housing, about recovery support, but also if somebody is ready for treatment, they can get them an appointment within a couple of hours with our urgent care over the phone and get them their first prescription of buprenorphine. And usually it's not their first prescription. It's that they've fallen out of care and they want to get back on it. And they don't need an appointment. They don't need anything. They just get it over the phone, get started. And if they need support going to a pharmacy or getting the medication paid for, our recovery specialists and our funding pays for that. And then we get them back to their clinic or back to their doctor or find them a new place if there's been a problem where they were. And a lot of people are just, you know, have some transition that they lost treatment. And if we don't lose them and we can get them back into retention and treatment, it's really critical because it's so hard to get people into treatment to begin with. We really need a low barrier strategy for retention.

Okay. How many people do you have on that team? I'm sorry.

Everybody has like five jobs. So overall we have about to people who 14 everyone partly works on the 15 navigator, on the phone line. 16 And -- 17

And they work just in the Kensington community or does Penn service citywide?

They work through our center which is in West Philadelphia. We have a presence with the Police-Assisted Diversion program and a presence at 265 Lehigh in partnership with a new program there.

And how many people have you all been able to provide services through this program?

Through the telehealth program over 3000 patients over the past three and a half years.

5000, over 5. I just looked at the numbers. Interestingly, of those 5000 they all received prescriptions. But in 2024, there were 12,500 calls. So there were calls for many, many other things besides medication, just substance use, navigation, harm reduction, education, family members call to try to, you know, research how they could help their family members. So 12,500 calls in 2024.

And before I turn it over to my colleagues, in addition to fentanyl you mentioned more drugs are making it out into the streets which we all know about, right. Are hospitals, harm reduction, wound care and other institutions equipped for this quickly I guess everchanging drug supply? And what is your recommendation to this committee to better support these efforts?

It's a really important emerging problem. You know, we've reacted to xylazine. We've created wound treatment and other things that we've evolved in response to xylazine. And now, the xylazine has been somewhat replaced by this new adulterant, Medetomidine. People are having really severe withdrawal like nothing we've ever seen. I've been in practice for a long time. Between September and January between Temple, Penn and Jefferson, we had 200 patients admitted to the ICU which is really unheard of for opioid withdrawal. So it's really a whole new category of challenges in withdrawal management that is I think throwing everyone a curve ball. We have some strategies to manage it, but they're not really available in less medical treatment settings. Even in the emergency department, most of these patients can't even go to the floors of the hospital. They have to do a couple of days in the ICU. And we're working very diligently to try and figure out how we can predict who's going to get that sick. But that has spread to fear of providers accepting patients into treatment who may get sicker and patients who are dreadfully afraid of getting too sick wherever they end up going into treatment, just what you said, Councilman.

For those who are listening to this hearing, what is that number that you mentioned that folks can call if they were interested in treatment, taking advantage of the program, the CAMP program or treatment in general through Penn?

Sure. So it's called the Care Connect Warm Line. And the number is 484-278-1679 9:00 a.m. to 9:00 p.m. seven days a week.

And that's funded by the Philadelphia Department of Public Health.

Thank you for that. The Chair mentioned or the Chair recognizes Councilmember Mark Squilla.

Thank you. And I was going to ask you a question on that because I mentioned it earlier, but I think you made it very clear that that is something we need to work on and find a resolution for and really how important our outreach workers are and what we could do to help our outreach workers, right. If you had a -- it sounds like you're saying it's hard to get people into treatment. We had mentioned about a dashboard. I don't know if you heard about that when we were talking about that earlier. If you had access to something that you knew where certain level beds were available for different individuals and they could go instantly, would that be assistance to an outreach worker that they're talking to somebody and say, hey, I have this, we could get you here now, we could get some transport person and get you into service, would that be something that you would think benefit more people and get them into treatment?

My understanding is that there have always been beds, that beds are not in short supply. The path to get from a person to a bed takes a little too long. I think, as you were pointing out, they don't get medication along the way. Even if they come to my emergency department they might get medicated after a pretty long wait and then they're going to wait again when they go to a CRC to get placed. So there's many steps that are challenging. I think the beds are there. We're working on streamlining the process but also that whole fear of withdrawal, when people still end up at that bed, including some of the ones that are at Penn, again both the providers and the patients are reluctant to go in this current environment because they're unsure -- like most treatment facilities would not have the medications that we're using in ICUs to manage this withdrawal. And again, it's not everyone. I don't want to cast this big net to say nobody can get into treatment, but it has caused a lot of challenges right around the time that we've deployed a lot of other efforts.

And I think that we've done a pretty great job with learning what company provides what services. Like Merakey and Penn, like we all work together, we do. So if we have a participant that's ready for treatment, we know where to send them to get an assessment, to get transportation or if they want to go to a shelter, if they want same day methadone induction, we can do all those things and we always work together to help people. It definitely breaks a lot of the barriers because there are certain things we can't do and there's certain things Merakey can't do. But when we work together, it does help the process a lot.

Exactly. That coordination is something that we need to get better, right, we need to get better at. And I think the goal is how do we get that coordination to work where it's almost instantaneous, you know, your efforts. Because you're on the ground, you're in the field, you see it, and then there are people that may want to go in that instant and it's got to be frustrating, even for the outreach worker when they do and you're stumbling, fumbling, not you personally, but it's hard to get through our process that we have set up.

There's a lot of barriers. I mean, medical clearance, what does that mean, it's this evasive thing. But you sit in an emergency department, a patient is, and they get sicker and sicker waiting for medical clearance for things. So there are many barriers that we have faced trying to get people where they need to go.

And the access to medicine, I know Councilmember Harrity mentioned that earlier, and there is I guess a methadone mobile unit that's going to be or close to being out there. Is it possible if we could do that and get where they're not getting sick where they have to leave, to be able to do that in a way that more than one provider could do it, right? And so, what would that look like in a pure sense of a perfect world if you knew you could do it, what would we need to do in order to get that access to those individuals?