COUNCIL OF THE CITY OF PHILADELPHIA SPECIAL COMMITTEE ON KENSINGTON Rock Ministries 2755 Kensington Avenue Philadelphia, Pennsylvania 19134 Thursday, July 18, 2024 10:05 a.m. PRESENT: COUNCILWOMAN QUETCY M. LOZADA, CHAIR COUNCILMAN CURTIS JONES, JR., VICE-CHAIR COUNCILWOMAN NINA AHMAD COUNCILMAN MICHAEL DRISCOLL COUNCILMAN JIM HARRITY
Good morning, everyone. Welcome to the Philadelphia City Council and the Special Committee on Kensington and the -- is this better? (Yes.)
Yes, better. Okay. Good morning, everyone. (Good morning.)
Let me hear you. Good morning, everyone. (Good morning.)
Welcome to the Philadelphia City Council and the Special Committee on Kensington. I now note that the hour has come. Will the Clerk please call the roll to take attendance. Members who are present and in attendance, will you please indicate that you're present when your name is called.
Thank you. A quorum of this Committee is present and the hearing is now called to order. This is the public hearing on the Special Committee on Kensington regarding Resolution 240510. Mr. Clerk, will you please read the title of the resolution.
A resolution 9 authorizing the Special Committee on Kensington to convene for the purpose of investigating and addressing the barriers to accessing treatment beds in the Kensington area.
I will start by giving opening remarks followed by Vice-President or Vice-Chairman -- you hear me, I just graduated him -- Vice-Chairman Jones, and then I would like to invite my colleagues to say a few remarks if they would like to do so. I would like to welcome everyone to the Special Committee on Kensington's first hearing. This Committee is dedicated to fostering a collaborative effort to analyze and evaluate efficacy of current policies and develop data- driven solutions to restore stability in Kensington. Through open dialogue and an inclusive decision-making process, the Committee strives to create a more cohesive and resilient community for all its residents. This Committee will focus on narrow and specific subjects such as long-term housing, employment and transportation. Today's topic is a product of feedback that we have heard from meetings, town halls and gatherings where people express how difficult it is getting into treatment. This is unacceptable and something that government has the responsibility to fix. Today we will explore the disconnect between providers who say we have plenty of beds and people on the ground who say they cannot get into them. The goal of this hearing is to begin to resolve this disconnect and identify areas that we can target in the short- and long-term. Vice-Chair.
Thank you, Madam Chair. I want to applaud my colleagues of the Kensington Caucus. A year or so ago we were in Conwell Middle School and we made a commitment based on those hearings, based on what we heard that we would be consistent in our approach to addressing the issues here in Kensington. We want to also thank Mayor Parker's Administration for being partners in this regard. We are not -- we're ending the operation of silos, silos of information, silos of resources through hearings just like this so that we can better provide services to the people here. We said at that hearing a year ago that until Kensington be safe, the city of Philadelphia, no 8 neighborhood is safe. And if you think that some of the issues that happen here aren't in other parts of the city, sometimes it's their little secret. But if you don't go to the source and address it head- on, it will continue to fester. And we're here. We came back. I remember some of the comments from the people, the stakeholders in the community that said, yeah, this is one-and-done, it's election time, you're not coming back. But our Chairwoman has been 10 toes down in making sure this Caucus works with the Administration to address it. It's not going to happen overnight, but we're going to keep coming back. We're going to keep learning how to build a plane while we fly it too. That's right. We want to thank members of the Administration for working with us to provide the information and the resources to make a difference here in Kensington. Thank you, Madam Chair.
Thank you. The Chair recognizes Councilmember Harrity.
Good morning, everyone. I don't think it's afternoon yet. Listen, this is personal for me. I live here. I'm also in recovery. I don't understand. A bed's a bed and that's what we want to get -- UNIDENTIFIED SPEAKER: We can't hear you.
A bed is a bed as far as I'm concerned. I don't care what the rating on that bed is. If somebody is waiting to get into a treatment center and we have a bed available, that bed should be available to them. We'll worry about where we transfer them once they're in there. It's about getting them in there at that point in time. So for me, a bed's a bed and that's what we want to get to the bottom of today. Thank you.
Well, thank you, Madam Chair. And I want to publicly once again commend you and this Committee. I am one of the newer members for having the courage to do this and to understand that we're not going to let perfect be the enemy of good, right. That's one. Two, we're going to be working with the Administration. And one of the things we have discussed is we need a dashboard. We need a dashboard with the information about all these beds that we keep hearing about, this conflicting information about who has what and really streamline for our community what exactly is happening, what is in realtime happening and what is the process. So it's hard to do all of that. We ask for the patience of everybody as this plane is being built, but we also need to communicate effectively during this process. So as someone who comes from a science background, I am invested in making sure this is an evidence-based process, and I also challenge our medical establishment when they talk about harm reduction to talk about harm reduction for everybody, including the community members who live here and don't have a disorder. We need to think about everyone when we talk about harm reduction, and we need to send a message loud and clear that we are here, we are going to make this place inhospitable for those who supply these drugs that are killing us, so they understand that it is not business as usual. So thank you all for being here and thank you to all those who are going to give us testimony because we're listening carefully to make sure we move forward effectively and in an evidence-based manner. Thank you, Madam Chair.
Thank you, Councilmember. The Chair recognizes Councilmember Driscoll.
Thank you, Chairperson Lozada, for convening this special hearing. It's very important. Thank you to the testifiers for taking your time. We know it's not easy taking time out of your schedules and we appreciate it. And with that, I'll yield my time to the talented testifiers.
Thank you, Councilmember Driscoll. I'd like to recognize that State Representative Danilo Burgos is joining with us today. Thank you so much for being here. Will the Clerk please call the first panel we have to testify this morning on Resolution No. 16 240510.
Yes, Madam Chair. Dr. Lara Carson, Dr. Chris Martin, Dr. Philip Durney and Dr. Megan Reed.
Good morning. Please state your name for the record and proceed with your testimony. Thank you for joining us this morning.
Thank you. My name is Dr. Lara Carson Weinstein. It's an honor to speak with you here today. I'm a family doctor and an addiction medicine specialist. My career at Jefferson is focused on improving the health and the health care experience of people with substance use disorders and serious mental illness. Beside me are my colleagues, Dr. Philip Durney from Hospital Medicine and Dr. Christopher Martin from Psychiatry, who both lead the inpatient Jefferson Addiction Multi-disciplinary Consult Service, and Dr. Megan Reed, Assistant Professor of the Department of Emergency Medicine. We are passionate about our work and strive to help improve the lives of people who use drugs. There are a few things on which we can all agree. Addiction is a complex and chronic disease of the brain. Addiction in Philadelphia is associated with astonishing threats to physical health such as limb-threatening wombs and severe infections of bone, heart, brain and spinal cord. And finally, addiction and associated physical illnesses are treatable. The challenge comes not from a lack of knowledge or passion, but from a mismatch of available resources and an outdated system design, making it very difficult to provide comprehensive treatment within a system of disjointed pieces of medical, mental health and substance use care. We will focus our remarks on the consequences of this mismatch and conclude with examples of innovative solutions that will require programmatic and policy changes within organizations, hospitals, the City, the state, the federal government to bring these programs to scale. Together we can then finally improve quality of life of the entire community. I'd like to briefly review some background information about fentanyl and xylazine. Fentanyl is a highly potent synthetic manufactured opioid with a short half-life leading to severe withdrawal. People who have developed a dependence on fentanyl are at extremely high dose of overdose risk if they receive so-called detox without ongoing treatment and access to the full range of medications where opioid use disorder, including methadone, buprenorphine products and injectables and naltrexone along with ongoing supports. Xylazine is intentionally added to prolong the sedating effects of fentanyl and has become almost ubiquitous in the local drug supply. Xylazine withdrawal causes severe increases in blood pressure, anxiety, irritability and frequently complicates the treatment of opioid withdrawal.
Oh, Philip Durney. In Philadelphia emergency departments and acute hospital settings are often the most frequent contact point for people with severe substance use disorders who are seeking inpatient treatment. We are skilled at treating both acute withdrawal syndromes and severe medical complications of drug use, but the severity of both diagnoses has grown more complex and increasingly harder to manage. Due to the dynamic drug supply, our patients are suffering from severe complications of drug use that often require prolonged treatment interventions, like weeks of intravenous antibiotics for infection control, aggressive wound care management and rehabilitation from amputations and spinal cord injuries that have rendered them unable to move or function. Most inpatient substance use treatment facilities that offer rehab beds are unable to support these patients' ongoing medical needs. This has created a large mismatch between supply and demand. Each rehab have specific criteria or levels of care that determine who can be accepted to receive both medical management as well as treatment for substance use disorder. There is a large group of patients who are well enough to be discharged from the hospital but are too sick to enter substance use treatment and thus, are not accepted by most facilities.
Dr. Christopher Martin, Department of Psychiatry at Jefferson Health. Besides medical complexity, there's an additional large group of patients who have complex and undertreated psychiatric conditions. While treatment can begin in the acute care setting, even once stabilized sometimes patients with serious mental illnesses are frequently not accepted by substance use treatment facilities. Opportunities for intensive inpatient substance use treatment are lost because addiction facilities are not equipped to support people with medical or psychiatric comorbidities, including suicidality and are locked patient psychiatric facilities, which are increasingly freestanding outside of medical surgical settings, often do not have the capability or expertise to manage more complicated detoxification or withdrawal complaints. This leaves our most at-need patients either effectively held hostage in general medical surgical beds with the limited addiction care that small consultation services can provide or discharged to the community and highly vulnerable to the ongoing vicious cycle of recurrent substance use disorders worsening medical, surgical and psychiatric conditions and social chaos. All of this is to say that while more rehabilitation beds may be helpful for patients who have severe medical or psychiatric comorbidities, which frankly describes the vast majority of the patients we care for on our addiction consultation service, we have a dire need for rehabilitation beds in the model of the DBHIDS Level 4.0 post-acute program with the expertise and motivation to treat the increasingly complex population we treat here in Philadelphia. Expanding the capabilities of such programs as well as making them accessible to our many patients not currently eligible for City-funded programming due to legal residence established outside our city or state or due to lack of compatible insurance coverage. What we have repeatedly found clinically is that our patients who require but cannot access this sort of multi- disciplinary care inevitably return to our care sicker and more complicated than before. This is simply not sustainable for our patients or for our health care systems which continue to be strained by increasing demands.
And I'm Megan Reed, the Department of Emergency Medicine at Thomas Jefferson University. And I'm going to be speaking today about a report Jefferson recently released about the opioid use disorder treatment system in Philadelphia. The funding for this report came from Pew Charitable Trust. And for this study, I led a series of focus groups with certified recovery specialists, people with lived and living experiences of substance use as well as the consumers of the services here in Philadelphia. The most powerful finding from the study was that many people aren't reaching inpatient beds in the first place because of their experiences of withdrawal during the assessment process. There are six City-run assessment centers where someone has to physically go to answer a series of questions before they can enter treatment. Some people said that once they arrive the process could last up to hours. 14 This would be arduous for 15 anyone but for someone going 16 through withdrawal, it is typically intolerable. Dr. Weinstein referenced the fact that xylazine is in 99 percent of the opioid supply in Philadelphia now. Xylazine is associated with the unique and agonizing withdrawal syndrome. People come to an assessment center highly motivated to engage in treatment and some leave discouraged and unlikely to return again due to that wait. I think there are real opportunities here for creative innovation. Can we find ways to make people more comfortable while they wait while working to shorten the waiting time period? We should roll out the red carpet when someone is ready for treatment, not put up obstacles for them to get in it. The next massive barrier to treatment entry that people in our study spoke about was access to housing. After inpatient treatment, people are often discharged back onto the street which is extremely destabilizing for somebody trying to stop using drugs. There are programs like Journey of Hope that work with patients on a long-term housing plan upon completion of the program. This can be a great incentive for people to go into treatment if they know that they have a place to go once they get out. The location and the neighborhood of treatment was very important to people we spoke to. Some people simply don't want to receive treatment in the same neighborhoods where they were using drugs. One of the certified recovery specialists told us -- this is a quote from him -- the guy who's been using dope and fentanyl for the last 10 years and is trying to get it together doesn't want to go back on the El to the spot where he was getting high. There's a lot of studies that show that muscle memory. He had every intention on going to the clinic, but he wound up in the shooting gallery. There should be no wrong during the treatment, so we need to explore all options for locations of care. We also need a variety of types of inpatient treatment. For example, many people seeking treatment are part of a couple and they aren't willing to be split up. These people need options to stay together while receiving care or they won't complete treatment even if they enter at all. We need resources for monolingual Philadelphians that speak Spanish. People in our study talked about many times where people enter treatment and cannot communicate with staff or their peers in group. We need more facilities for people who speak other languages and more programming specifically for subpopulations of people accessing treatment like LGBTQIA+ people, people who are actively parenting and more. I'd like to close with a quote from the community-based certified recovery specialist who summed up a lot of what my colleagues have been talking about when he said, there's just not enough, there's not enough detox beds, there's not enough rehab beds, especially with the opioids that are out here now. We're seeing flesh wounds where there's tendons, there's bone, there's major muscle damage, right.
There's only 70 beds that will take patients like these, so a lot of these people wind up discharging to stay at skilled nursing facility, if they're even willing to accept them, because if you have substance use disorder stamped on your chart, nobody wants to deal with you. And a lot of these patients wind up being discharged back to shelters, back to the flop house, back to the streets. These are really difficult and complicated issues to tackle. I'm going to pass this back over to Dr. Weinstein who will talk about some innovative approaches that we've taken at Jefferson and some things we think can help solve the problems we've outlined today.
Thank you, Dr. Reed. Silo busting multi- specialty collaboration is remarkably effective in improving access to and retention in treatment. Innovations at Jefferson include reconceptualizing the addiction consult service into an ecosystem of care for people who use drugs. This means that care starts even before people reach the hospital through communication with our tremendous community partners such as Project HOME and Pathways to Housing. It means starting withdrawal treatment while people are still in the emergency department and supporting them through our certified recovery specialist program in partnership with the Council of Southeastern, Pennsylvania and PRO-ACT. It means that one addiction consult can open the door to many services tailored to the person's needs, ranging from dedicated infectious disease specialty teams or inhospital recovery groups led by our addiction consult social worker. Importantly, care for people with substance use disorders at Jefferson does not end when people leave the hospital. They have walk-in access to our comprehensive Bridge program five days a week where they can receive treatment with buprenorphine, coordination with methadone, counseling, primary care, social determinant of health support, and importantly, seamless ongoing access to specialists like hepatology, cardiology, orthopedics and neurosurgery who have treated them in the hospital. So how can we make further improvements to this system design? We have a critical need to eliminate the mismatch between the capabilities of our rehabilitation beds and the involving and complex medical, surgical, psychiatric and addiction needs of the patients we are caring for in Philadelphia. This care must be accessible to all people in Philadelphia, whether insured publicly, privately not at all or within the carceral system. We need clearly delineated paths of care for ongoing needs such as wound care, injectable antibiotics, acute physical rehabilitation and further psychiatric stabilization. Let me conclude by saying that our team is here to help. We have the privilege of working with people who use drugs every day in the hospital, at the clinics and on the streets. At Jefferson we're committed to a whatever-it-takes approach to care for people with substance use disorders and complex medical problems. What we need is a fully integrated system and payment system to allow people to continue their healing journeys and return to their communities, not just to recover from substance use but to reclaim their lives. Thank you.
Thank you so much for your testimony. This is just the first panel and I'm already frustrated. But thank you so much to Jefferson. Thank you for the time that you all have taken to meet with my staff to talk about some of the research that you all have done, and thank you for your commitment to this crisis. I have a few questions and then I'll open it up to questions from my colleagues. In the OUD report that was released in February there's a section that identified barriers to beds, and you mentioned some in your testimony today. Can you take a few minutes and give us some more details and also how to implement these recommendations in communities like this one where it's ground zero as well as across the city where we are seeing some of this activity move to?
Sure, a few things come to mind. One was already mentioned, having a dashboard. It was very difficult to figure out how many beds are available, what the capacity of the system is. That was kind of one of the things we are tasked with to find out, what is the current state of the system. It was really hard to figure that out. I think there's needs to be a dedicated position at DBHIDS because I don't think it's feasible for them to do it with the existing resources they have to keep that information up-to-date in realtime so that I can look it up as somebody with opioid use disorder who's accessing treatment, somebody on our addiction consult service or certified recovery specialist can look it up to find out what's there. People can figure out what the current availability is of the system and match people as a way of kind of breaking down that silo and getting information directly to people. And then I spoke about location a bit. One other thing I'll say about location is that sometimes people have been removed from a program for having a conflict with a staff member or another patient or they've left on their own accord because it's just not a match for them at that program. So having more locations, again rolling out that red carpet, you know. If I live in South Philly and I don't want to get treatment in South Philadelphia because I don't want people to know my business, I should be able to go to another neighborhood to get care. If I lived in Kensington, it would be triggering for me to go get treatment here. I need to have another place to be able to go. Same thing if I live in North Philadelphia and I just don't like Program X, again being able to go to South Philadelphia. We need a citywide system.
I always find it interesting how -- and I mentioned this earlier. I mentioned it multiple times. I find it interesting how we can get a flight anywhere, we can get an Uber, we can get DoorDash, we can get all of these services brought to the area where it's nearest where we are at the moment that we need it, but when we're experiencing a crisis and we can't figure out how collectively we add all of our information into one place to be able to allow for a police officer, outreach worker, a resident, a family member, just anybody to be able to figure out where are these beds. So I'm hoping -- I appreciate it. I appreciate the recommendation of a dashboard, right, because if we can do all of these other things to socially feed ourselves and make us happy, we should be able to find a way where people can go online at any time of the day to figure out where we can get someone who is in a crisis situation and connected to the needs that they have. So, yes, I completely agree we need to figure out how that happens. And I mention that in many of the meetings that I've been in. And one of the pushbacks that I've gotten is that there are these laws, right. There's laws that prevent us from being able to, for instance, reserve a bed for someone who said I'm ready to come into treatment. There's a payment structure that people might won't want to share information about. There are categories apparently that go into these beds. I want to follow up on what Councilmember Harrity said, right. If someone comes to me and says, Councilmember, I'm ready for treatment right now and it's o'clock in the morning, I want to 4 be able to go into a location, 5 reserve that bed and have an outreach worker come and pick that person up immediately and take them into the bed. I don't care what the category of the bed is. We can get them into that bed, stabilize them and then move them into a more appropriate space, right. But everybody that we talk to in this field says we have a window and we need to respond within this time frame. And so, for me I'm hopeful that at the end of the conversation we figure out how do we create that dashboard where those barriers of what kind of insurance they have, what kind of bed is this is ID'd or submitted, where the loc -- I don't care where it is. I'm hopeful that we can get to there. But can you tell us how often do your patients experience I want to come in or they've shown up at Jefferson and you have for some reason or another not been able to continue to provide services or provide the service that they need and get them into a more long-term care after you've been able to stabilize or address their critical need when they come to your door?
If you can just speak into the mic because these mics are a little special.
My name's Phil Durney, Department of Hospital Medicine. I run the Addiction Consult Service with Dr. Martin. So we talked a lot in our testimony about this concept of mismatch, specifically when patients are presenting. If they're coming in -- some patients present to the ED as a contact point that aren't even in withdrawal. They're coming in seeking treatment or bed availability, and we've been trying to come up with innovative ways to reroute those patients so that immediately they can meet with a community health worker or social worker and not be admitted to the hospital. The issue arises when patients have these really severe medical complications. The Level 4 program has opened a lot of doors us. But when patients are coming in with really severe infections, life-threatening infections or severe debility like they can't walk, they can't move, that's when this mismatch occurs and we stabilize them in the hospital. We treat their medical complications and we start addiction services that are very comprehensive in the inpatient setting. The delay happens when patients are looking for rehab, and the rehab cannot accommodate the medical complexity of the patient. The Level 4 has been great for that, but what's happening is there's other levels that are different criteria through ASAM 3.7, 3.5 which have their own criteria and specifications. We have a lot of patients that have wounds and we're trying to work with these programs to expand their ability to care for some of these medical complications. The patient will wait and kind of digest the inpatient setting just waiting to find a bed just because they happen to have a wound and they can't meet criteria because of something as simple as a wound. And most of our patients, the majority of our patients have wounds now, as just one example, not to mention other infections.
Thank you. The Chair recognizes Councilmember Harrity.
Well, first I'd like to thank all for -- I thought my voice was pretty loud. I'd like to thank you all for coming out today -- UNIDENTIFIED SPEAKER: Can't hear you.
Hello -- no? All right. We're getting it. I want to first thank you all for testifying. Thank you all for testifying and also commend you on your efforts. The Bridge program is one of the most comprehensive plans I've seen in a long time being somebody from recovery. You know, Lara and Sandy Stein are great people. And I met with them when they were thinking about this many, many times and talked open with them about recovery and what it was about. And I'm glad to hear that you guys hit on some of the most important sticking points. I'm also telling my colleagues that after actually getting them into the rehabilitation to get sober, the two important things after that point is housing and mental health. Most of us out there are just self- medicating for some form of trauma that we faced either as a young adult or a child, you know. Also, Dr. Reed, what you said struck me. When somebody's using in South Philadelphia and they go to get into a recovery program, they might not necessarily want to be in a program in South Philadelphia. It's funny, we have a lot of clichés in recovery. One of them is people, places and things. The same people in the same places lead you to do the same things. So I'm glad to know that you guys are thinking about all that in one. My question is I guess as a doctor how would you guys figure out this labeling of beds? Again, as far as I'm concerned a bed's a bed, and I get that some people have other medical issues that they have to do. But I believe we need to be working all hands on deck like our Mayor has said, break down the silos and have not only the medical doctors treating the wounds but the mental health people there with them, and just get these people situated until we can find a bed that's more compatible to them. How can we implement something like that?
Thank you. It's a really great question. I think as the psychiatrist with the team I feel pretty passionately about this. A bed is a bed, but the bed has to be safe and if there's suicidality, if there's acute psychosis, they have to be safe with themselves and the other patients who are there trying to get well. If they need intravenous medications, you need the means by which to safely deliver those medicines. So the bed needs to be upscaled to the complexity of patients that we're treating right now. That will reduce the backlog in the hospitals and give everyone an opportunity to get care. I think there are a couple of different routes into addiction training. I think one of the really interesting things about addiction medicine and addiction psychiatry training if you can come in through the psychiatric residency, you can come in through a variety of medical or surgical specialties as well as through addiction medicine that are funding for opportunities for that training that involves giving up a year as an attending. You have to motivate people to seek that sort of treatment -- or seek that sort of education rather medication. I think the more physicians we have from different medical backgrounds, the better we'll be able to handle the medical complexity and then increasing the level 3.5, 3.7, 4.0 beds including the pilot program I think is the answer to the problem.
The way this problem is now and is progressing, as your testimony has shown, most of these people are going to come in with underlying medical issues, most likely wounds. So I mean, the simplest thing I can think of was just mark them all 4.0 or whatever and let's make those beds available. How do we get more of those beds, because the bottom line is the longer this goes on the more of these people are going to be coming to us. Most of them have wounds. It's part of the addiction. It's part of them using. They do not take care of themselves. With the tranq it gets infected. The body's actually rejecting the drugs and that's what's happening, am I correct, and it's pushing it out of the body through these wounds. And this is a common problem. I don't know. What would you think would be the percentage of people that are coming to these programs with wounds and trauma nowadays to be put into that criteria of a 4 or whatever?
Great. Thank you very much for that question and for all the questions. I want to make a really important point, that I cared for folks, as we all have, these wounds go down to the tendon or bone. And it has gotten to that point because they are leaving unsheltered and exposed to the elements. Some of those folks are not ready to come in for intensive care but they come to see us in an outpatient clinic. And with the incredible wound care from the Project HOME nurses and nurse- practitioners training the rest of us, those wounds can heal completely with standard dressing and soap and water, basic human rights. So we need Level 4 beds, but we need a society which I believe we can create where people's wounds don't get to this point. Now, we are in a crisis right now so what are we going to do. I hear you. I think there is truly a role for triage and we have talked about this as a group. If there was an influx of folks coming into our system, they would all require medical triage because some would get very, very sick in the jail, in the recovery center. But I think with creativity and allocations for a period of time to work out this triage system, get those that need the hospital to the hospital, those that need Level 4 to Level 4 and so on. I absolutely think we can do that. We're from Philadelphia. We can do anything.
I agree. I agree. We're a city of the first class, right. (Applause.)
Before I recognize my colleagues, I think it was Dr. Reed who said there are individuals that don't want to receive treatment where they were using, in the communities they were using. Can you say that louder? Can you say how often that happens because it's part of what we have said, right? It's part of what the community of Kensington has said. Not only do they not want folks to continue to live in addiction in their community, they recognize that these individuals need services but they don't believe that providing them with services in the same community where they are using is going to be successful for that individual, right, nor is it going to improve the quality of life in this community. Can you speak to that a little bit and tell us in your research what you have found and how often do you hear that?
Megan Reed. So a couple of things come to mind when you ask that question. One is the feeling of different types of treatment. So getting away from location of care. Different programs are going to have different approaches, right. Hopefully, they're all evidence- based, provide medication, et cetera, at just minimum. But some are going to have a more spiritual focus, some are going to have less of a spiritual focus. There are different things that are going to work for different people. And for that reason alone, we need different types of treatment in different locations around the city. People have really different motivations for why they want to go to a certain place. Some are very emotional. Some are very pragmatic. One reason for a clinic to be located in Kensington as if somebody lives in Kensington and they're parenting and they need to stay close to home or their job is in Kensington, it might be more convenient for them to access treatment in Kensington. If they live in Kensington and it's triggering for them to receive treatment here, they need to be able to go outside of Kensington. So I think you can make an argument that there is a need for treatment both inside as well as for every location outside of Kensington. That's what I would say. And again, with getting into treatment I keep thinking while my colleagues are testifying about this woman that I've been working closely with who's actively using substances, she's been doing research in partnership with me and she keeps showing up with wounds and she keeps showing up into treatment centers and they say, come back when your wound is healed. So she gets her wound treated, she comes back and she has another wound. And these are not severe wounds. These are not advanced wounds that she has. I think providing basic wound care treatment education to people at those centers can help them get treatment the less complex wound where it's really an excuse to not take a patient.
Thank you. The Chair recognizes Councilmember Jones and then Councilmember Ahmad.
Thank you, Madam Chair. My question is how many and how much does it cost? So when we start talking about Tier 4 and this, those are pricing structures where you can get reimbursed probably by some source of medical assistance, I get that. It's okay to do good, but you have to know how much doing cost. So what I need a little bit of clarity on is what is the universe of need, what is the universe of availability of beds, what is the optimal time in your professional opinion where someone needs to stay in recovery to be successful? In another life I was on a board of a recovery entity and one of the statistics that scared me was that there was a 95 percent relapse rate that was in the course of doing business. If we were trying to make McDonald's burgers and 95 percent of the time we failed at making a burger, we would be out of business. So help me understand optimally how long if you could just have a magic money want how long does on average -- I know everybody's an individual -- how long on average does it take for someone that has a fighting chance of success? And what I'd like about what you said, Doctor, was that triage, one size does not fill all. The folk that come to our prisons, they have a whole different trajectory and reason for being in recovery than the folk that come in willingly. How do we triage and then send them on the appropriate course for people that are dual diagnosed because if I don't fix one, the other one is not going to be fixed too? I know that's a lot. But how many and how much?
I'm going to ask Dr. Martin to answer that. However, before he responds to that you mentioned a 95 percent relapse rate. I want to just make sure that we're clear that evidence-based treatment with methadone, buprenorphine and naltrexone is associated with a 50 percent decrease in all cause mortality for people with substance use disorders. Even the statins, atorvastatin do not have that high level of decrease in mortality. So we've been doing a lot of things outside of science for a long time when back in the day addiction was a moral failing. Now that we know it is a chronic treatable disease, there's no 2 reason to have a 95 percent relapse rate with what we have and what we know.
Thank you. A very complex question. To try to peel all some pieces of it, it depends very much on the amount of support that a patient may have outside of the hospital, do they have housing, do they have families who can provide support or other natural support that are available. I agree with everything Dr. Weinstein said. We need to think of this, all substance use disorders as relapsing, remitting conditions and there may be returns to use that need not be as severe as the initial incident that brought them into medical attention in the first place. I think this is why the ASAM criteria exist. It would be one thing to make everybody Level 3.5 or but there are patients who can do very well at lower levels of care because they have some of the supports. So it helps guide exactly what you're speaking to, the resources to the people who need it most and if patients are maybe agreeable to a lower level of care, outpatient, intensive outpatient with the supports to manage that, we get them to that level of care as well. But many of these patients need --
Dr. Gurney and I treat patients in the medical surgical setting. That's the setting that I practice in. I treat patients while they're in the hospital, but these are relapsing, remitting conditions. Very often that's some degree of treatment for life. That treatment may be stepdown to medication management and therapy or therapy alone, but that's kind of going down through the ASAM criteria for the level of care that's being suggested.
So a person right outside this facility on average, if you had the perfect program that you could design, how long would they need to be there and how much would that cost?
Unhoused patients who have no natural supports and are currently not in treatment, there is evidence that says that longer term treatments, residential treatments, 90-plus days for the initial, that that can be beneficial. But it really does vary entirely on the severity and what supports are available. I think we face unique conditions in Kensington given the degree of homelessness, nutritional issues, care of basic medical needs, hypertension, diabetes, they've gone untreated very often for very long periods of time.
That's also going to be quite variable between the insurance that's paying for it and the beds. I don't have answers for those questions. That would be better directed at people who run the rehab programs and the insurance companies that are paying for them. I wish I had clear answers for that.
Thank you. I'm looking forward to a day when we can say that there's some type of universal insurance that will allow people to come in and get the medical services they need whenever and wherever they need it, and we have to -- all of us have to work towards talking to our counterparts at the federal and state level to figure out how do we create that, right. If you're suffering from addiction and you're in Philadelphia County but you're from Montgomery County and you have Montgomery County insurance, I need to be able to treat you here. I need to respond to your crisis situation here, right. I can't turn people away because they don't have the appropriate card in their pocket. We need to figure that out. We need to do better at that. Councilmember Ahmad.
Thank you, Madam Chair. Is it on -- okay. Yes, universal health care, that's really universal. That's another goal for another hearing. I have so many questions, but I want to start with commending all of you to be here. You're taking time out of your schedules, busy schedules of treating people right now. And I'm particularly interested to understand what is the data that we have that shows everything that has been done up until now, and maybe you can answer that question, what has been the best practice that has evolved out of everything that we've been doing over the last, I don't know, 20, 30 years? What is -- it's sort of similar to Councilmember Jones' question. What is the optimal fact that we have seen regardless of -- there's going to be variations of the patient of course with comorbidities, that's a different kind of scenario, but overall what has evolved for us to be the best standard of care, which is similar to I guess the Bridge program? So I would love to hear what is that.
Sure. Megan Reed. I'm going to be a little repetitive of Dr. Weinstein and say that medications 100 percent absolutely, the shift in how we conceptualize and think about drug use into a more compassionate and also recognizing the agency of people who use drugs to be able to make rational decisions for themselves. And I think also the recognition that people need their social determinants of health addressed again with housing, wraparound services. You can't just plunk people into treatment and take them out of the lives that they were living for 30 days and then have them go out and be discharged into homelessness or go back to where they were using before without giving people additional support. Like Dr. Martin was talking about, it's highly dependent upon what sort of familiar supports they have, economic resources, whether they have a safety net.
So what I've heard was medically assisted treatment being critical and wraparound social services. This is nothing new. Even though it's data-driven and we know this is the answer, my question is how do we build in flexibility in these processes to adjust to different outcomes for people and also to work with, say, the intake services who like you said 16 hours while they're detoxing (inaudible), those kinds of devil in the detail things is what we really need to start feeding if we're going to build this system that is going to have medical-assistive treatment, chronic care, long-term care, especially around mental health services for people to sustain their recovery. So you have to deal with it as a chronic disease. It's a chronic disease where we can manage it where we can look to people to have actual recovery and sustain recovery but a very fragile one because you can get knocked off very easily. So I would love for all of you to try a system where you can say this is what we have, this is what we need, this is where the flexibility has to be built into the intake services, whatever that might be. This is where we have to have flexibility with our service providers who we are giving a warm handoff to. We need like a checklist of things we need to make to go along with our dashboard and have this checklist to say, two weeks is how long it takes for this one patient to go from this (inaudible) position to (inaudible).
I have a lot to say on this topic, but I'll keep it brief. Again, my name is Phil Durney, the Department of Hospital Medicine. I worked at Jefferson as part of a committee and a design group that created a dashboard for our hospital system. We have a role of air traffic control in the hospital. We used the EMR and we created a very dynamic dashboard to track outside hospital transfers, emergency room admissions, patients coming from the office and we were able to create this dashboard that has a brain of how to follow these patients through the inpatient setting. And I think that this dashboard has a lot of potential to a lot of the points that you've already made. If we just fix one piece of this process, this is a continuum. So if we sent someone into the hospital and then they go to get placed to a Level 4, what happens after they leave the Level 4? If they don't have access to housing or they don't have access to a residential program to transition them, then the wheels can come off again. So I think this dashboard has a lot of promise, not just of tracking the patients of where the acute beds are available but actually tracking and rectifying this fragmented care that's happening in our community so that we can track patients throughout the entire community as they traverse this landscape of seeking treatment.
So you already have a dashboard, Jefferson. So it was a conversation with our other support systems that need to come into it to be (inaudible) for our city to the Department of Health potentially to be the house where we put all of this, which would still have connections to the providers, to Jefferson and small providers so it would be like a brain, as you said, that would have all these nerves in the system, going out all the nerves and the entire system so we can then see where every (inaudible) so we would love to get it.
So I do want to also -- the Jefferson program is well-advanced. There is a smaller pilot program that Jefferson, my colleagues at Penn, my colleagues at Temple, under the leadership of Project HOME and the Estadt-Lubert, collaborative are actually piloting a dashboard going all the way from acute hospitalization to respite beds to permanent supportive housing. It's a huge undertaking and we're starting on a very small scale. But with the support to evaluate this and scale it up, there's a lot we can build on and learn. And we have already put a tremendous amount of blood, sweat and tears into the process.
And this is to Councilmember Lozada's point of getting our federal partners in this process. The reason why we have these drugs coming into our city is a federal issue. We can only do so much. This is a law enforcement issue that has not been handled which is why we are left with the side effect of all of this, right. So I think having us make the advocacy pitch to state level and federal to really roll out comprehensive dashboard with our realtime interventions can be where we want to go and clearly you guys have already different models for it. I guess my question is what do we need to do -- what is going to hold us back for actually making it a citywide, city-driven or be afraid to be city-driven with the partners in a private sector?
That is one of the most straightforward questions. Money.
That is why I mentioned the federal government, right, which is why we have a state with $15 billion dollars out there (inaudible). This should be a driving force if we want our economy to survive, right. This should be moving us from the poorest big city to a status that we need to be. This is all things that make us in that status. So we need all advocates, but we all need a comprehensive plan to move forward. We can't move forward without a plan in place. And this is partly why we're having this hearing to see what emerges as a solid plan with everybody, all stakeholders involved and we can push to say we have evidence-based, we've seen it work at a smaller level. We can scale this up and we can all be partners in doing that and we would love to see everyone working on that. So I thank you all.
Thank you. I think we find money for everything else, right. We just came out of a national pandemic, right, and we found money. We quickly shifted gears and readjusted and we found money to be able to respond to the crisis that we were in. And I think that it's convenient for people to talk about this being a health crisis, but we don't seem to be able to figure out how do we shift gears to be able to respond to the health crisis that is taking place right here in this community, right. And so, I have a problem with it being about money. We have to be able to find it wherever it is because I think it's actually necessary to change how it is that we're responding to the crisis that is happening here. The Chair recognizes Councilmember Driscoll.
Thank you. Madam Chair, I'll be brief. I know this panel has to get back to work. Two quick questions, Dr. Durney. You had mentioned that some folks are too sick to be sent to treatment. What happens to them then?
So depending on the severity of the medical diagnosis, like for instance if someone has a heart valve infection or a severe infection of their brain or their spinal cord, we have to keep them in the hospital while we proceed with medical or surgical intervention. But what our team has done and I think across the board in the City at a lot of acute care hospitals, we tried to bring addiction management and long-term management into an inpatient setting, into a system that is not designed or optimized for these resources for patients. So when Dr. Martin and I see patients in the hospital, a lot of the majority of our interactions with them are talking about their acute medical complications, but we actually focus on -- and I say this to patients all the time, what is your life going to look like and what is your journey going to look like when you leave this test tube, these four walls. We have access to medications here but when you leave the hospital and you have interactions with different people or places or things as we mentioned, that's really where the rubber meets the road and I think that that's usually the issue of when things kind of fall off the tracks, and housing and support are so crucial to that.
Right, but you're not long-term now and you're not a full long-term treatment center. What's the trigger when you need that bed and that person is not quite ready for treatment? If you're uncomfortable to answer it, that's okay.
I think the trigger is we're trying to decompress the hospital because we have such a high volume of these patients coming in, but it's where the patient is with accepting and coping with some of their illnesses, right. That's a large part of this too. We have patients that we have to perform amputations for. They have life-changing -- we make life-changing medical decisions. We encourage them throughout the process during their inpatient hospitalization to proceed to these beds if available and if you feel like they meet criteria for them. Sometimes patients give a little bit of resistance because they feel like they're not going to receive the same kind of level or caliber of care or support. But in a lot of these instances with the Level 4 program, it's actually better for some of the patients to leave the inpatient setting because it's more targeted therapy and they can continue to get the medications and support that they need at these programs. So we are trying to mobilize them out of the hospital as quickly as possible when they're deemed medically stable.
Councilman Jones' question earlier, while I don't have the money figures for each level of care, I can guarantee you that Level 4 and Level 3.5 is significantly less expensive than another day in the medical surgical hospital.
And real quick, Dr. Weinstein, and I thank you for highlighting, there's a lot of people that I still don't think understand it's not a moral failing but it's a chronic disease. We deal with folks all the time that will say, no, they're just weak, they're just this, they're just that. Actually Patrick Kennedy actually convinced me many years ago that it was a brain disorder just like liver cancer, any kind of disorder like that. And I know it's more complex than this, but fentanyl I believe was designed to get people out of real severe pain, right? I think that was its original intent. Does your hospital still use fentanyl? And if so, do you buy it from -- your purchasing department just buys it from a drug manufacturing company?
Thanks. That's a super interesting question. And, yes, fentanyl is a very important drug in folks with anesthesia and severe acute pain and pharmaceutical grade fentanyl is really life-saving in these situations. But the issue is that illegally manufactured fentanyl can be made in a lab relative to growing a field of poppy seeds and processing that to make heroin versus opening a lab and making fentanyl. There's no comparison as to the speed and the efficiency and it's such a smaller amount to distribute internationally. So there's a lot of very smart people getting the fentanyl out and we need to match that with our field.
Thank you. The Chair recognizes Councilmember Harrity. But before that, I want to go back to the money situation. As a city, we've received millions in opioid settlement costs. We need to figure out how we use the funds that we received to be able to use it to address the needs that we have, right. And so, at some point later on in this conversation I'd like to figure out why and how can we consider that, right, how do we consider using some of those dollars that we currently have and redirect them to creating opportunities that would help really address the crisis that we have. And before Councilmember Harrity, I'd like to recognize Council President Kenyatta Johnson has joined us. Thank you so much, Council President. (Applause.)
When I went to Council President and said, Council President, we have a Public Safety Committee that responds to the public safety issues in our city but we need a special committee that will just speak to the crisis that we're experiencing in the Kensington community and it needs to be separate from the Public Safety Committee. I didn't have to advocate a whole lot. He recognized the need to be able to create a committee where we can specifically have conversations about what is happening here. So I just want to express my gratitude to Council President Kenyatta Johnson for also understanding that this community needed to be prioritized. So thank you very much, Council President. The Chair recognizes Councilmember Harrity.
Just real quick -- I'm sorry. Just real quick. Those of us who are in recovery, the guidelines for recovery changed. As an example when I first got sober the first time in '88, '89, we were taking our psychological medication. Before that time when my father first got sober in early '80s, he was a Vietnam vet suffering from post-traumatic stress, and the rule was no mindaltering substances, so taking his actual psychological medication wasn't allowed for his recovery at that time. And because of the Vietnam vets and their struggles with post-traumatic stress, we figured out that wasn't necessarily the better case. They couldn't get any real time if they weren't on their psych meds. And I'm glad to see that we're going that way with the maintenance medications, some of which are better than others. Methadone and Suboxone is one type of maintenance med, but there's another one that actually only has to be taken like once a month or something like that. What is that medication and how much now is that being used compared to some of the other medications that are taken daily?
Dr. Christopher Martin. There are a couple of injectable options. There are multiple brand names for buprenorphine which is the active ingredient Suboxone that you mentioned, so that can be given monthly. And also, naltrexone. Naltrexone, Vivitrol branded, has a long-acted injectable form as well --
It blocks the effect of it. There's an alcohol treatment medication that will make you physically ill.
Because that's kind of a matter of catch 22, right. Some of these maintenance medicines actually make people ill (inaudible) and I guess it's just the -- I'm sorry. So it's just the preference of the client of which works better. So in your opinion which medication would be a better fit?
And that's a very personal question with individual patients and their providers. I will take a bit of exception to the euphoric effects of methadone and buprenorphine products when prescribed appropriately. When prescribed appropriately, they are preventing withdrawal. They may be managing pain, especially under patients who have chronic wounds, neuropathic pain after some of their medical and comorbidities as well. But I would not say that when they're prescribed appropriately that they're causing euphoric effects.
I'd like to thank you for being with us today. Are there any other questions from the Committee members?
There being none and before the Clerk calls the next panel, I'd like to call Council President Kenyatta Johnson for remarks. (Applause.)
Well, first I just want to say good morning. I just wanted to take time out of my schedule today to come support the work that the Special Committee of Kensington has been doing and most importantly just inspired and powered by your leadership, so anything that I can do to continue to be supportive of your efforts. I think when we talk about breaking down barriers to treatment we should be doing everything we can to do possibly, especially around the Kensington issue, but overall when it comes to dealing with those who suffer addiction, we should make that process easy for anyone who is seeking treatment. So whatever I can do to be supportive, don't hesitate to let me know. But I am inspired by your leadership and how y'all are working together. This is a very comprehensive group of individuals. It takes a very, very comprehensive approach to deal with an issue that is very, very significant here in the city of Philadelphia. And so, I'm going to get back to the work at hand, but I just want to thank everyone who came. But most importantly, I see the Administration is here so it's going to have to be a partnership to get things done, but I'm also inspired by the leadership of the members of City Council. You started from day to make this a priority and we won't be one-and-done. We will be back until we make sure we eliminate this issue. And so, I'm just thanking you for having this and I wanted to come and show some support. (Applause.)
Thank you, Council President. Will the Clerk please call the next panel to testify.
Thank you for being with us this morning. Please state your name for the record and proceed with your testimony. I'm going to ask that you speak into the microphone and try to project your voice so that folks behind you can hear.
Great. Okay. Good morning, Councilmember Lozada and members of the Committee. And thanks for the opportunity to testify on this critical topic. I am a Philadelphian and a resident in Councilmember Squilla's District and I'm also a addiction medicine physician at Penn where I focus on providing care for patients with substance use disorders both in the hospital as well as in outpatient settings and focus on progress to improve access to substance use treatment. Today I'm testifying on my own behalf based on my experience as an addiction treatment provider and researcher for the past 10 years. Over this time I've witnessed the severity of the crisis in our city but also the fact that substance use disorders are treatable. And has been noted by City Council, we are facing many challenges in promoting treatment access. Some of my comments will likely amplify the remarks made by my colleagues at Jefferson, but I'd like to sort of highlight three obstacles to care that we are seeing for people experiencing addiction in Philadelphia as well as some of the strategies we've taken at Penn and across the City. So the first is really insufficient services across the continuum of care. We talk a lot about rehab beds as a solution rather than thinking more broadly about the wider continuum of care for patients with substance use disorders. I do want to be clear that rehab is a really important and helpful treatment setting for patients, especially for those with complex medical conditions or without a safe place to live, and often a first step for the patients that we're talking about right here in Kensington. But we also need to remember that addiction is a chronic condition that persists long after an individual completes their stay in a rehab facility and we need to be prepared to offer high-quality longitudinal care to promote recovery. We absolutely need more high-quality rehab beds in Philadelphia and we need beds, as has been mentioned, that can manage both complex withdrawal symptoms and medical complexity that's associated with our current drug supply. We also need high quality and comprehensive outpatient care. In the context of opioid addiction, this means rapid and consistent access to medication treatment like buprenorphine, Suboxone and methadone. We're setting patients up to fail if we're not providing this care as these are the gold standard of medications that when prescribed over the long-term promote health and recovery. Along with outpatient care, we need to recognize that a lot of treatment is happening in general medical settings, including primary care clinics, emergency departments and hospitals. In Philadelphia and in Kensington, just specifically as was mentioned, we're seeing patients with increasingly complex medical conditions such as severe infections and wounds, and the presence of xylazine in our drug supply is only exacerbating this trend. It's also worth noting that access to sterile needles is a critical factor in combating complications and reducing the spread of diseases like HIV and Hepatitis and we anticipate the complications like wounds and infections will become more prevalent and severe in the absence of sustainable funding for needle exchange programs. At Penn, we've built an interdisciplinary addiction medicine consult service, much like you heard about the one at Jefferson. And I know that hospitals across the City are working hard to build up our inpatient services. But we need to recognize that patients need additional support services following an inpatient environment. Upon discharge, patients experiencing addiction often need nursing home care, medical follow- up, substance use care and a host of other services to get their lives back on track. It's difficult for anyone to navigate this complicated need of services and it's especially hard for patients without reliable transportation, phone access or housing.
Accordingly, as a city we need to additionally focus -- in addition to some of the things already mentioned, focus on improving transitional support. Too often I encounter patients who leave rehab, hospital or jail without adequate medication, follow-up or help for their addiction, medical or social needs. We need to invest in support services to ensure that patients can navigate our incredibly challenging system. I can share that at Penn we've implemented telehealth and some increasingly inperson transitional services through our Care Connect program, which provides care navigation. And I'm happy to speak more in detail about this as part of our questions, but we need to think about how to broaden the services sort of long- term for patients so that they can access any care that they need ongoing, more rapidly and without barriers. The second area I'd like to highlight, which has been mentioned before, is the mismatch between the treatment options that are available in our city and the patient needs. As has been described, the complicated needs for medical care, addiction treatment and social services are a real challenge. And the models that account for these multiple complexities are lacking. For example, as you've heard patients seeking substance use treatment who also have infections or wounds struggle to get into rehab that has the capacity to care for these issues. Patients who need nursing care after hospitalization can't always continue to receive substance use treatment in those nursing facilities. For example, many nursing homes will not accept patients on methadone. It's also very difficult to attend outpatient appointments if you're disabled by chronic wounds or you lack adequate housing or transportation. In light of these challenges, we need to think about investing in programs that can concurrently address the medical substance use and social needs of those experiencing addiction. The last area I'd like to highlight is the persistence of policies and practices that create barriers to ongoing treatment. We know that treatment, particularly again as has been mentioned, medication for opioid use disorder improves outcomes for those living with addiction. And what we really need to think about is prioritizing in our city same-day access to these effective medications and making it easier for people to stay in treatment by adopting approaches that prioritize medication support as soon as possibly and deliver care to people when and where they need it. This includes same-day initiation or re-initiation of medications like methadone or buprenorphine and use of adequate and up-to-date doses of these medications without restriction as well as removing other outdated policies that prevent people from staying in treatments like discharge for one episode of use, like zero tolerance-type rules. Programs with punitive policies often exclude who they are ultimately trying to help. On the other hand, programs that are willing to meet patients where they are and employ harm-reduction principles foster a more effective treatment environment. You may have heard that a harm reduction organization -- people who interact with syringe service programs and other harm-reduction organizations are five times more likely to enter treatment than those who don't, and I think that's because these types of programs are often the only places where people feel welcome, safe and cared for. If we want people to remain in care and ultimately improve outcomes, we need programs that meet their needs and treat people with dignity. So to conclude, we all of course want to help people suffering from substance use. We can do that by investing in proven treatments for addiction, shoring up the continuum of our substance use disorder care and improving social supports like housing. We need to focus on high quality evidence-based treatment and low barrier access to medications like buprenorphine and methadone.
We need to continue to invest in comprehensive inpatient and outpatient treatment service for those with medical complexity. Thank you again for the opportunity to testify and I look forward to your questions.
Thank you for your testimony. I think that one of the things we're going to recognize today is that all of us are saying the same thing, right. All of us want the same thing. The question is how do we get there, right. A year ago we met with a lot of providers and we met with community residents. We talked about what the issues were. We're still talking about the same issues. We need to figure out how do we move forward, how do we change how we're responding to this crisis and connect people without all of those barriers. Every person that has come up here today has talked about very similar barriers. And so, can you tell me how do we begin to minimize or eliminate completely some of those barriers that we know well prevent people from getting into these beds? And can you also talk to me a little bit about the more warm-line program that Penn Medicine has that connects patients to beds? Tell me about that program. Is it much easier for folks to get into beds when they're coming to your program? Can someone from off the street, can an outreach worker refer someone into this program? How does that program work and how do we start to peel off some of the barriers that we're talking about?
Sure. Those are great questions. So I think the first question of just sort of how we address some of the barriers to beds, I would just amplify some of the comments made by my colleagues on the prior panel. I think more transparency around sort of how people can get referred, where their space is important. I think improving or kind of adding staff that can address sort of higher levels of complexity within a rehabilitation setting is critical. So they mentioned sort of the Level 3.7, the Level 4, those are the ASAM levels of care. But in order to implement those, you need staff who can safely do wound care, administer medications, things like that. And so, I think outputting more of our beds to that higher level would be very helpful. I think also there's inevitably some waiting period, some shuffling around. It's never going to be snap your fingers and someone's going to get into a bed. So I think we need to have strategies that we can stabilize patients while they're waiting. Those who are in the hospital we can keep them and continue to medically stabilize them while they're admitted. For those coming from the community seeking treatment, it's difficult to ask for someone to sit for 15, 20, 30 hours waiting for a bed without any sort of treatment. So if there are ways that we could -- they don't necessarily have to be in a bed, but if there are ways we can sort of expedite that care that I think will go a long way as well. So those are a couple of thoughts about inpatient beds. I think just to expand further on outpatient I think we need more walk-in kind of low-barrier services, whether it's methadone access on the same day, whether it's buprenorphine access on the same day, those are the primary modalities to treat opioid addiction and we need those to be available as soon as possible for anybody who wants them. Speaking of Care Connect specifically or the warm line, it's the Care Connect Warm Line is the full name, that's a program that we've developed at Penn at primarily telehealth-based, although we do have some inperson staffing and it's really designed to provide exactly the type of services I'm talking about. It's a single phone number staffed by a skilled and compassionate substance use navigator, some of whom are people in recovery, some of whom have case management backgrounds, who answer the phone seven days a week, hours a day, and really 8 the goal is to help people to 9 figure out, help sort out what 10 their needs are. 11 So the patients are 12 triaged, they ask what are you looking for, how can I help you. If it's buprenorphine or Suboxone, we are able to route them to a provider on our telehealth urgent care line at Penn which sees people for a variety of conditions all day and all night, but they can do buprenorphine starts there. If it's methadone, if it's inpatient treatment, they provide sort of personalized navigation to that patient to figure out how they can get to where they need to be. A lot of this is done in partnership with our hospital, with our community partners. Some of it is with PAD. Some of it is partnered with Merakey centers. I think what's really important to highlight is the emphasis on the relationship because there is no single solution for every patient. But what we do need is a knowledgeable -- what we try to provide is really the knowledgeable navigation that can help patients get plugged in quickly into this very difficult- to-navigate system. So again, we can do same- day buprenorphine starts. We can get patients assessed for inpatient and we can get them quickly plugged into methadone all through that initial phone call.
And is your program available and accessible to patients 24 hours a day, 7 days a week?
Right now it's 12 hours a day, 7 days a week. I think we would like to expand it. And funding is always a limitation, but I will say it is available to anyone in Philadelphia. It does not have to be a patient at Penn and it does not have to be a patient who has insurance. We can cover uninsured patients as well.
And do the providers that provide services to residents or to those living unsheltered on the streets of Kensington, do they have information about this program, are they aware of this program and do they have access?
They certainly have access. I know we've made a lot of efforts to do outreach, but we're always excited for more opportunities. I'll just say that I think one of the biggest challenges is when we're talking about people experiencing unsheltered homelessness and some of the most severe social and medical challenges, people don't always have a phone to call us. So we're working and actively working to expand some of our inperson services so that we can provide these same treatments and care not solely to people who can call us on the phone, but we also accept phones from outreach programs and things like that. So, yes.
Are there any questions from members of the Committee?
Thank you for your testimony. I wanted to just go back to the point that this is a chronic treatable condition. When we have something like another chronic condition like diabetes and have a prescription, Metformin or whatever and they're taking other assisted resources for that person to be successful, but they have to keep going and you the caregiver prescribe this whole scenario of these things that need to happen, I would love to see if you would prescribe the follow-up as medical care, meaning post- hospitalization when they go into actual maybe long-term and they go out on their own where they're still getting medically-assisted treatment to stay opioid-free, can you have like a check-off on the screen that tells you what this patient needs to get and it can be a medical prescription? Can you prescribe the full continuum of care is what I'm saying?
Not in a traditional way, I guess. I think that sort of developing a bundle of services that is a checklist is something that I know we do. I think all the hospitals do as part of their addiction consult services. I think rehabs do that as part of their discharge. But a lot of it is the devil's in the details and sort of getting patients where they need to go, navigating various barriers that come up. As far as the medical treatment, we do recommend sort of long-term prescribed medications for opioid use disorders, buprenorphine and methadone. And those are administered in, you know, buprenorphine can prescribed in many different settings, including primary care where I do it. Methadone can be administered in methadone clinics and both are set up to do longitudinal treatment. But again, I think there is not always sort of reimbursement or funding for these other wraparound services, the coordination piece and all the things that actually allow patients to get where they need to be to maintain their medication, maintain their counseling, whatever the treatment is.
The reason I say this is there needs to be one entity that is watching this patient starting from the in-hospital care all the way through, like a primary physician who takes care of a child, you know, a pediatrician takes care of all the things, the shots, the regular checkups. I just would like our medical community to think like that so that your job doesn't end just doing the Suboxone or -- all those other things that need to happen because this kind of support will not be useful with a relapse if those other things are not in place. So I'm just asking for a medical home for a patient with all these wraparound services and to make this a priority in order for us to see real progress in this arena.
I think that's very much something we all are hoping to do. I think Dr. Carson Weinstein mentioned the Project HOME model that we're all a part of. It's in major health systems. And I think many of us provide this care in a primary care setting and are hoping to continue to build those models. So thank you for that.
Yeah. So it's really building an accountability in this process, that you come in for this care but it doesn't stop here in order for this treatment to be successful and there's an accountability for everybody in this process to make sure that patients are successful in staying in recovery. So I don't know how you measure the accountability, how we make it a priority. But that's where I think we need to go once we coordinate all the services. Thank you, Madam Chair.
Penn Medicine has a mobile care unit in this footprint, correct?
Some of our -- there's a research mobile care unit. And some of our providers work on other organizations' mobile units. I'm not sure which one you're referring to.
Does a mobile care unit from Penn Medicine park somewhere in this community to provide services to those who are suffering from addiction or those who need it?
I'm not sure at the current moment if they do. But they have at times, yes.
Okay. And can you tell me during their time or during your time how many individuals have you all been able to connect to beds through this program?
I'm not personally involved in that program so I personally can't speak to that, but we can direct you to -- we can help figure that out to be helpful.
Okay. I'd like to know that. If you can share that information with this Committee, that would be awesome. And then can you also tell me, we have outreach workers out in this community. Who do you have a relationship with that as your direct context that would help to bridge patients to the beds that you all have available through this program on the ground here in Kensington?
So to be clear, we don't own any of the beds with Care Connect. We connect patients to the beds that exist already, but we have partnerships with many of the agencies here. I know that we work closely with Merakey. We work closely with Prevention Point. And I think also with DBHIDS. We've partnered with many and met with many of them a number of times. But again, always happy to do more of it.
Thank you, Doctor, for all you're doing for this important topic. Do you see resistance from the providers in trying to engage with you to -- if they have available beds, are they afraid to share that information because it's sort of private stuff that they don't want out there to see the success or not success of their individual program? Do you see that?
Are you referring to program level metrics or patient information, like individual patient information?
I mean, just trying to assess the bed availability and program availability.
I know that for example on our consult service when we're trying to discharge a patient who needs a rehab bed, it's typically a process where a social worker will call back, do a number of different communication strategies to a bunch of different rehabs. They will review the charts and let us know what capacity they have so there's not a huge amount of transparency, but I think that's probably going on across the city in a pretty inefficient way. And so, some of the discussion around dashboard or greater transparency will be helpful. Yeah, that's probably the best answer I can give.
Yeah, I sense that reluctance too. I worked for a credit union and we had folks that did the title insurance. So we had a ton on our list and then we had a wheel and we just switched the wheel. Every time a new customer came in, we would refer it out and then you can even do regional, that sort of thing. I just don't feel today that we have that wheel built yet to spin, and that's where I think some of the frustration is coming from us and I know you're trying and I know there's a lot of competition in your world in health care right now. We're not trying to create winners and losers in the marketplace. We're just trying to solve a problem. So thank you, Doctor.
If you could help us identify -- if you can help us be more transparent, right, and identify how successful has Penn been in the Kensington community connecting people to some of those beds, it would also help us, right? And so, I think that's what we're really looking for. We're really looking for you're in the community, you're providing services. This sounds like a program that can really help people transition into living very healthy lives, right. Because the way the program was explained to me was Penn can connect people to beds much easier than other programs in this community. And so, I'm trying to figure out what are those successful numbers, how many beds do you have access to, where are those beds and how long do people stay in those beds, what are the challenges that people have when they first walk in and what are the challenges that they can experience on their way out and how do we provide those wraparound services to help them be successful? That's really what we're looking for.
I would just say that again we have access to the same beds as everybody else, but I think what we're doing through this program is sort of being able to provide individualized navigation and kind of decongesting EDs or assessment centers and really sort of assessing patients in our own setting and helping sort of sort out a variety of needs while they wait for a bed or while they get plugged into outpatient treatment. So I wish -- but unfortunately we don't have any access to any special beds or beds that are not available to other places. But as you've heard, many different institutions and settings are working to get patients into the same set of beds.
Hello. How are you today. So there's been a lot of talk about the beds but also the outpatient programs. Actually the first place I ever went was Penn's outpatient program on 40th and Market back then in the '80s. But I would like to know your opinion on the people that we're dealing with right now. I know when I first went to Penn's outpatient program I was 17, I was young. While my addiction was pretty heavy, I hadn't had a lot of time of being out there or I guess my bottom was different, right. So we say hitting bottom, my bottom was different from when I was to 12 when I end up going back in a 13 second time. But in the second 14 time I fully believe there was no 15 way I would have been in an 16 outpatient program. I needed to be 17 somewhere where I was in a facility. In your opinion -- I mean, I get like sticking maybe in an outpatient program just to get them in some place until we can find them something else, but in your opinion do you think an outpatient program would actually work for these people?
I will say I see it works. I mean, I do this care myself. It's not everybody. Like you've heard many times, it's hard to give an across-the-board answer. It depends a lot on the patient and --
Right. And I think it is very difficult to care for your wounds, care for your substance use and do other things if you're unhoused and that I think is a big barrier. But I will also say that I have myself seen patients get better who are unhoused. And again, medication and low-barrier supports play a large role in that. And so, I think both are needed. Even for people who go to rehab or inpatient, we still need those supports afterwards in that same capacity.
Are there any additional questions for the panelist? (No response.)
Thank you so much for your testimony. Thank you for joining us today. (Applause.)
Will the Clerk please read the names of the next panel.
Commissioner Marquita Williams, Deputy Commissioner Amanda David, Andrew Devos, followed by David Holloman, Deputy Commissioner Pedro Rosario, Joelle Anderson and Noelle Foizen. (Applause.)
Thank you for joining us this morning to provide testimony. Please state your name for the record and begin your testimony. And we are going to begin with Marquita Williams, Interim Commissioner for DBHIDS.
Very good. Good morning, members of the Philadelphia City Council Special Committee on Kensington. I am Dr. Marquita Williams, Interim Commissioner of the Department of Behavioral Health and Intellectual Disability Services. Joining me today are Amanda David, Interim Deputy Commissioner of DBHIDS, and Andrew Devos, Chief Operating Officer at Community Behavior Health. Donna Bailey, CEO of CBH, was unable to attend today. I am pleased to provide testimony today on behalf of the Department of Behavioral Health and Disability Services. I would like to start by acknowledging not only the individuals who are struggling with this disease but also families and entire communities. I know that this topic elicits a great deal of emotions and certainly frustration given the complexity and necessity of the involvement of multiple systems. DBHIDS' approach is to enhance the continuum of service options in which the level of service matches the behavioral health needs and circumstances of individuals seeking behavior health services. CBH, DBHIDS' contracted Medicaid-managed care organization, has served as a cornerstone of Philadelphia's behavioral health system maintaining a comprehensive network of approximately 200 behavioral health providers. Through a contract with DBHIDS, CBH pays for, coordinates and manages access to a wide spectrum of substance use disorder programs and other behavioral health services for Philadelphia Medicaid recipients. In their role CBH does not provide SUD or mental health services. They pay for these services which are delivered by behavior health providers in our network. CBH does not control the Medicaid member eligibility or enrollment, which is the state county assistance office's responsibility. CBH can only pay for the medically-necessity behavioral health services provided by our members. Access and availability: Access and treatment beds in Kensington is indeed a significant concern. The availability of treatment beds directly impacts the ability of individuals struggling with addiction to receive timely health and support. There is no 6 waitlist for treatment beds. However, there is a waitlist for recovery beds that ranges from 175 to 250 beds individuals daily. CBH takes a bed census three times a day. m. We are currently working on building a bed registry that will help streamline availability and referrals through CBH's network, which includes approximately 1,874 SUD beds. CBH does not own or manage these beds but contract with behavior health provider agencies that own these beds and can deliver the SUD treatment. Individuals can access critical treatment services through the provider network, which includes 80 SUD treatment service locations operated by one of our 36 in-network SUD treatment providers. In 2023 over 23,000 members utilized SUD services, just under a quarter of our nearly 100,000 utilizing members. Over 28 percent of our adult utilizing members had a substance use disorder in 2023. Opioid-related disorders were also the third most common primary behavior health diagnosis amongst adult aged 18-plus who utilized services in 2023. To help locate available beds, the CBH psychiatric emergency services team assist health care staff with identifying available SUD beds, makes care recommendations and shares treatment history to ensure our members access the care that they need. All levels of bed base are provided by CBH in-network providers are forms of medical treatment and are not housing or shelter. As the Medicaid payor that receives federal and state funding specifically to pay only for health care services, CBH can only pay for medically-necessary behavior health services.
After an individual decides that they want treatment, among the next initial steps to accessing services involves receiving an assessment from a behavior health provider, a mobile crisis unit, an outpatient clinic or an emergency department and our crisis response center to determine what treatment is best for that individual member. Emergency departments and crisis response centers both operate 24 hours a day, 7 days a week. Here are actions that we've taken to remove barriers to SUD treatment and enhance access: Since 2021, DBHIDS has required that all substance use disorder providers in our network deliver care in alignment with the American Society of Addiction Medicine or ASAM, as you've heard here today. The ASAM criteria include requirements for developing four levels of recovery-oriented, evidence-based SUD treatment services, each designed to meet an individual's specific treatment needs. The ASAM criteria covers SUD screening and assessment diagnosis and a determination of the best level of care for an individual based on their current symptoms. To reduce barriers to care, we have also removed prior authorizations, a decision-making process where a provider must first request that CBH approve a treatment as medically necessary before the individual can receive the treatment. This year, 2024, we removed prior authorization for medically managed withdrawal management formerly referred to as detox. 5 ASAM care, which includes medically-managed residential SUD care for individuals with serious psychological or social issues who need 24-hour oversight and who are at risk for imminent danger to themselves or others. For many individuals who have experienced an overdose or are on the verge of an SUD crisis, this is the initial treatment environment needed to stabilize the individual's SUD symptoms, prevent overdose, deter relapse and begin the recovery process. DBH has also taken various steps to ensure access to medication-assisted treatment or MAT through the SUD-covered service continuum. Since 2019, we have required all in-network drug and alcohol outpatient clinics to provide MAT directly in their clinic or have a clear linkage with the clinic that can provide MAT services. In 2022, CBH also expanded contracts with our in-network provider Temple Health, which is the Episcopal campus, Penn Health Hall-Mercer location and Friends Hospital to allow for the payment of MAT induction in their crisis response centers, which includes a total of three locations. Additionally, CBH is now conducting an MAT accessibility survey with SUD in-network providers to access the availability of MAT across the network. Additionally, DBHIDS meets regularly with CRC clinical and medical directors to ensure barriers to reaching SUD treatment beds as a next level of care that there are no barriers. When an in-county provider is at capacity, CBH will authorize an out-of-county bed-base level of care. The CRC staff then works with the out-of-county provider to arrange transportation typically provided by the provider to transfer the member to the out-of- county bed. There are service expansions to reduce barriers. Since 2018, CBH has issued several procurements to expand contracts with in-network providers and have taken other steps to make the following SUD service expansion. We made the addition of 200 additional SUD beds for residential substance use disorder services. These were added to the bed ability to the network in 2022. We've increased the low-intensity SUD residential treatment service availability in 2022 through expanding contracts with existing providers. There are four new regionalized intensive SUD outpatient service programs. These were also created in 2022 through expanding contracts with in-network providers. We've increased our outpatient addiction services also in 2022 by expanding contractors with additional in-network providers such as the Wedge Recovery Centers and Kirkbride.
These resulted in the Wedge offering Medicaid-reimbursable services at a new location and enabled Kirkbride to expand their outpatient SUD services, allowing Kirkbride to provide a full continuum of SUD services. We've also increased our partial hospitalization program offerings, providing MAT in 2022 treatment for occurring treatment and other behavior health diagnosis. This has resulted in 50 additional SUD partial hospitalization slots for CBH members. These services include 20-plus hours of weekly organized outpatient treatment during the day for people with SUD who need intensive routine care but who do require 24/7 attention in a residential SUD facility. Further, we've entered a contract or contracts with out-of-network providers to provide methadone induction. Additionally, we've added mobile home care in collaboration between Kensington Hospital and DBHIDS to conduct wound care services and outreach to individuals in the Kensington area and throughout the city of Philadelphia. The purpose of this program is to assess and treat wounds directly onsite in the mobile medical units. The mobile wound care vans also provide physical health clearance for admission into substance use disorder programs across the city. The mobile wound care program partners with homeless outreach, Rock Ministries, PDPH, PPD, the Managing Director's Office and community providers throughout Philadelphia. This program has partnerships with providers with health systems throughout the city as well. Additionally, we are continuously examining network capacity with an intent to issue necessary procurement to ensure continued access and availability of services. The growing presence of xylazine and fentanyl and opioids used in the street, which causes severe wounds and infections among users, has also increased the need for high-quality SUD bed base care. In response, in 2023 DBHIDS launched the Level 4 ASAM Post- acute Wound Care program in partnership CBH, Kensington Hospital and Eagleville Hospital. This innovative program provides post-acute hospital-based SUD care to individuals who need intravenous antibiotics. To be eligible for the program, an individual must have been hospitalized in the medical unit, have severe wounds and need a PICC line for intravenous antibiotics. Since 2023, over 200 people have been admitted to the program with majority completing the program and continuing in their recovery. Most of the substance abuse disorder treatment providers are accessible via public transportation with the exception of a few out-of-town bed-based providers. Individuals who receive an assessment and require that level of care are transported to the program via ambulance and/or taxi. The DBHIDS Mobile Outreach and Recovery Services Unit also works to provide linkages to recovery support and substance use treatment. MORS has engaged over 2,000 individuals and facilitated 346 linkages treatment and is able to facilitate more rapid access into treatment by providing assessments from within the community. Waitlists: DBHIDS has partnered currently with a consulting group to work on strategies to look at effective ways to decrease wait times. The consulting group has collaborated with DBHIDS staff to assess the barriers reported from both the crisis centers and the treatment providers to better understand the concerns and possible challenges leading towards long waiting times. Based on the responses, a work group including the providers will work together in developing processes to eliminate any gaps that will impact the delivered services. Couples and families: Treatment programs are for individuals. However, Philadelphia does offer several SUD programs where women can receive treatment with their children. In order to ensure access for individuals across the developmental life span, we are working to advance maternal health equity and access to SUD treatment for mothers struggling with addiction as another top priority at DBHIDS.
In fact, in 2018 CBH launched the Mommy Helping Hand program. CBH Care managed, coordinate care for pregnant and postpartum birthing mothers with SUD and other physical and behavioral health conditions to meet their multiple needs. Our Care managers meet members in their homes and in other community settings, schedule doctors' appointments, educate them on health concerns and connect them to community resources. Additionally, DBHIDS has approved funding for a Journey of Hope couples program. 5 beds serving 8 couples. The program may be a first of its kind offering residential SUD services for couples. DBHIDS partners with many local health care providers and other organizations to connect our members with immediate SUD care. We work with surrounding counties and take individuals from these counties into programs that contract with our insurances. If someone from out of county is uninsured, we will work with the county, see what county authority to get the individual placed in the county of origin. DBHIDS works with the court system, PPD, housing and a number of other agencies to support the navigation and needed resources for all individuals in need. We understand that this is a complex challenging concern and it takes a multi-layered solution. We appreciate the ongoing support of Council and thank you, the Special Committee on Kensington, for giving us an opportunity to highlight the work of both DBH and CBH. DBHIDS remains committed to partnering with you, the Mayor's Administration and other stakeholders to address the SUD and our behavior health challenges facing Kensington and our great city. Individuals in need of SUD or other behavior health treatment can call our 24/7 member services line at 1-888-545-2600. And if an individual is in a behavioral health crisis, they may call 988. Thank you very much for the opportunity to testify before you today. My colleagues and I are available for any questions.
Thank you so much for your testimony. I'm going to move to have questions asked of Dr. Williams by the panel and then we are going to take a 30-minute break, and then we will return to hear the rest of the panel and then move on to public testimony. Thank you so much for being with us.
You started with there is no waitlist for beds. And I find that really interesting. I also find it frustrating and confusing, right. Because when we are responding to those who are trying to get into beds, there's always challenges, right. There's always -- we often hear there are no beds. And so, I'd like you to help me understand there not being a waitlist and is that a myth, is there miscommunication, is there lack of transparency? I'd like you to help me and the rest of the panel as well as those who are here with us today, help us understand where does that come from.
Thank you, Councilwoman, for that question. There are many types of beds. And when we say that there is not wait for beds, we're talking about our substance use disorder treatment beds. Earlier in my testimony I did say that there was a wait for some recovery house beds. But I think when people see, okay, so there is this large number of folks over here and then there's maybe a small amount of beds potentially, that those beds will get up eaten up quickly. And then there's this idea, well, there's no beds, because every day we hear this number of maybe 100 beds are available or 80 beds are available. I think the thing that's important, and there are a couple of points to be made here, is to remember that everybody who needs treatment doesn't need treatment at the same time. So there's a constant dynamic movement of people through our system. Also, everyone who needs treatment is not going to need the same level of care of treatment when they start. And then when you talk about readiness, we know that readiness is going to continue, and contemplation -- I think maybe it's time -- all the way up to action. And so, there's a lot of conversation about what's available, when people want it and what's not available. But if you look at our website every day, the number is there around how many beds are available. And it seems to be typically somewhere around 100 beds. What that also means is that if we have 1874 beds and only 100 beds available, at any given time you have 1700 people moving through the treatment continuum. So this idea that there are no beds, I think it may be due to what kind of beds people are looking for, misinformation. But we're here to give you the correct number, the correct information and to tell you where you can find it every day.
How many people do you think are living on the streets of Kensington today?
We're talking about 100 beds that you say are consistently available, right?
Would you say consistently on a daily basis, consistently on a weekly basis, on a monthly basis --
Just in this last week, today it's 121 beds. Yesterday it was 116 beds in the evening. In the morning, it was 108 beds. So it moves up and down as people move in and out of the treatment, the level of care that they're in.
What's the number of people that are living on the street?
How often does DBHIDS count the number of people that are in the street?
Hi. I'm Amanda David. I'm the Interim Deputy Commissioner at DBHIDS. And we do a quarterly count. OHS manages the winter count. We do a spring count, a summer count and a fall count.
In your last count what was the number of people that were living on the street?
We'll be back at 1 o'clock. I'd like to have that number. It's a number we need to know, right. If we're talking about the challenges that people are experiencing to get into these beds, we can't figure that out if we don't know what the number of need is, right. And part of our issue is that we can't ever get a consistent number, right. So as we're trying to identify the barriers to get into these beds, we need to be able to identify the number of beds and where are those beds. How many providers does DBHIDS contract for services here in this community, in the Kensington community?
I don't have the number of providers in the Kensington community, but there are 80 as to the treatment providers.
I'd like to know what the number of providers are that you all contract and fund in this community. I'd like to know how much you pay them to provide services. I'd also like to know what services are they supposed to be providing here as it relates to connecting people to services, right. And before they can get services, they sometimes have to go into that bed process; is that correct? They have to come in somewhere, right?
So if you all can help us understand, right, how many providers are here, who they are and what are the services that they're supposed to be providing, I would appreciate that. And I'd also like to know your last count. What was your last count and how does that compare to the number of other partners, Police, Office of Homeless Services and others who do a count as well. How does that differ, right?
Good morning, Council Chairperson Lozada. Dave Holloman, Interim Executive Director for the Office of Homeless Services. Just want to report on the number, according to our point-in-time count which the Office of Homeless Services continuum of care is mandated to do one count per year, the number of people that were counted this past January that were unsheltered was 976. However, there's three different methodologies when we talk about count. There's a police count that has an observation count, more of a census count. And then it's the DBH quarterly census count. Those numbers based on what police allocation range anywhere between 400 to 600. Again, those are observational count. The Office of Homeless Services does a methodology count that is vetted by HUD in which we're required to do. Those seasonal counts are done to look at trends. But for the last several years, the numbers in Kensington always continue to fluctuate depending on the season. However, this current year here when we have those consultation meetings with law enforcement and other partners, those numbers range anywhere between as low as 400 and upwards to 600 that's in the Kensington area. One of the things that we looked at during the last point-in- time count is the highest number of unsheltered individuals in the city of Philadelphia we're seeing in the Kensington area. That used to be the opposite for this area. It used to be Center City. So that's content there. DBH and Police can speak more about their methodology that they use, but I believe it's more of a census count. And again, seasonal to seasonal to look at different trends.
I appreciate that. Thank you. I'd still like to know what was their number. On the record I'd like to know what is their number for their last count.
The last number that we gave in the last hearing had to do with the number of engagements that were made by DBHIDS, the outreach team in Kensington. And that number was somewhere in the 600. We'll get the exact number again. But our number at that time was about how many people we engaged on the street.
And I'd like you to explain what's a successful engagement to DBHIDS and your outreach workers.
Hi. A successful engagement is any kind of connection we make with an individual to help move them toward a life of recovery. So an engagement could be building a relationship with the individual to eventually accept placement. But the goal is always to get the individual off of the street either into housing or into some level of substance use disorder treatment program. To date, we have actually done 5,000 engagements. It's not an unduplicated number. The continued engagement could be -- it could be continued engagement with one person or a set of people. We're going to get the unduplicated number, but we've also made 221 placements in the beginning of the year. So that could be into a hospital, it could be into a treatment program or it could be into a recovery house or safe haven, and emergency shelter. We work with OHS to do that as well.
So is it a myth that a successful engagement is someone accepting a bottle of water or is that truth?
Sometimes that's the entry into having a conversation with an individual. So a person accepting -- if you're handing out something that the individual needs, working off of Maslow's hierarchy of needs like giving them water so that they will begin to engage, trust you and create a meaningful relationship with you, sometimes that's the first step into moving toward these other -- moving toward placements, accepting treatment and those types of things. One of the things that we really like to do is get to know the individuals who are on the street so that we can help make the right placement for the individual to help make whatever placement is going to stick.
Dr. Williams, from the beds that you mentioned that you all have access to, what are the cost of those beds?