good morning the meeting will come to order the thursday october 27, 2022 meeting of public safety and neighborhood service. supervisor mar the chair and i'm joined by stefani and melgar and joined by supervisor mandelman this morning. thank you to stefani cabrera for staffing this meet and like to thank matthew from sfgovtv for staffing as well. madam clerk do you have announcements. >> thank you the board of

sprierdzs are convening hybrid meeting allowing in person and public comment and remote access and public comment via phone. equal access is essential when take comment as follows. will be taken on each item. those in person will be allowed to speak first then those on the phone line. for those watching 26, 28, 78 or 99, and sfgov.org the public comment number is streaming across the stream it is 415-655-0001. >> again, 415-655-0001. when prompted enter the id access code: 2486 793 5172 ##. >> when connected you will hear the meeting discussions and muted in listening mode only. when your item come and up public comment is called those in person lineup to speak along

the wall to your right and those on the phone dial star 3 to be added to the queue. if you are on the phone turn down your tv and listening devices. we will take public comment from those in person first and go to public comment phone line. alternateively you may submit comment in writing e mail to myself the public safety and neighborhood services clerk. >> or via mail forward to the supervisors will be forwarded to the supervisors and send written comments via post office to city hall items acted on today will appear on the board of supervisor agenda of november 8 unless otherwise stated.

>> call item 1. >> item 1 a hear to provide an update on the fiscal year 2020-21 proposition t. treatment on demand report and requesting the departments of public comment adult probation, sheriff's department. da department to report. member when is wish to provide public comment call 415-655-0001 then access code: 2486 793 5172 ## press story 3 to enter the queue. the system will prompt and indicate you raised your hand wait until you have been unmute exclude may begin comments when we go to public comment. >> thank you. thank you, supervisor mandelman for calling for the hearing on

the annual prop t on demand report and your leadership on the crisis in drug addiction and over doses in our city the floor is yours supervisor mandelman. >> thank you chair mar and members my apol joes to you and the audience for my tardiness. i want to thank the departments that have been so giving of their time. d ph, public defender i want to thank the coalition for engaging and service providers health right 360 and aids foundation. i said these before but they bear repeating. treatment on demand is more then and there a quarter century old in san francisco. we declare third degree our

policy in 26 years ago and yet near low 3 decades later it does not feel like we are there. and even worse, it does not feel like we exactly know what the gaps are and what providing meaningful treatment on demand in san francisco would look like or cost. meanwhile, parallel opioid and methamphetamine epidemics impacted lives with over dose deaths sky rocketing 478%. treatment on demand properties in 2008 are due by february first of each year. the notion is that the treatment on demand reports impact behavior in this belling the mayor will think about them as she crafts her budget. the board of supervisors think about them as we look at add

back funding. and pass the budget in the summer. this will be my third hearing since taking office in 2018 when we started, it seemed clear d ph had not taken reporting obligations seriously and had settle in the a habit of submitting 1-2 page reports that found the department was meeting the treatment on demand goals that of the ends and no need to talk further. and no one d. since, i do think the reports have gone from bad to better. but i still think there are unanswered question bunkham minot be asking all of the right questions not guilty first accomplice. reports may need to be rethought going forward. i am concerned we don't have a clear process for america unmeted demands despice the

ordinance requiring each report to have assess sdpment plan to meet the demand. i have follow up questions about the wait times in the report and how they are with the experiences prosecute voiders and community organizations and folks in criminal justice system connecting people with service every day. i look forward to hearing about partner efforts and to dig in any discrepancy between what folks are experiencing and what is reported in our treatment on demand report. we need to understand just how many we are losing as a result. without the data an analysis how much more are necessary seems hard or impable and we will tread water while the system is this year's report this is good

thingful highlights several opportunities improvements more residential step down services and treatment for spanish speaking clients and people with dual diagnose and in custody and injustice involved clients. butt report does not measure the extent of the gaps for the subpopulations much less propose policy or budget changes that would close those gaps. supervisor steph no and i joined supervisor dorsey in requesting upon departments work together on a comprehensive plan to end street level drug dealing and right to recover. i department supervisor dorsey effort in this area. but i think that the experience of treatment on demand suggests the ways in which the directions that go out to departments do what i think is a reasonable and personal thing to assess need,

come up with plans to close gaps and report back to us. can end up not playing out the way folks had intended. this is what happened with treatment on demandful san francisco recovery is treatment on demand on steroids and impacting all departments but i think we need to continue to get treatment on demand right if we make further progress. so e policies and plans are not enough am change requires focus from both branches of government, departments and public. and so that is why i call for these hearings and why i'm grateful for the partnership of the city departments and our providers. >> our firsts presenter unless anyone has things they want to say. i believe i wanted to note for

the presenters and you that because we have so many presentation in this hear and important information in discussion i think we are asking each to limit presentation to 5 minutes and madam clerk will have a timer on this to help reminds us. thank you. >>. d ph is up first. >> i'm doctor comings the director of behavioral health service and mental healing sf at department of public health. >> you have a cold. >> i do. >> recovering. first, thank you chair moore and vice chair stefani, melgar and our gratitude to supervisor mandelman for calling the

hearing. this it is a topic this is extreme low high prior to me personally. i have a long story of providing clinical care to people with substance use disorder and have been working over the last decades to improve system of care and access to care in order it save lives and support people's recovery. >> we will aim to answer your questions and look forward to your on going conversation. i want to really extend our thanks to profound low to the partners both who will be offering testimony today as well as others in the city who i have come to know. we are aim to be i department receptive and engaged with

feedback aim to improve as we go and grapple with the difficult but person issues. next slide. from the legislation i want to level that the as we understand the from the luthe d. public health min tain fro and low cost medical substance abuse services and residential treatments with upon demand. >> so, in this presentation, i hope to cover who we serve, the services in san francisco, funding for the services, cast and time liness of services and accomplishments and opportunity for improvement, next slide. i'm rushing a bit. >> first let mow call attention to national data.

answer address the question how many access substance use services nationally. this statute national survey on drug use and health the government conducts. y we know among people with substance use less then and there 10% need treatment receive it. and most people with sud at the time of the survey don't foal they need treatment despite the presence of the disorder. and this is a major gap. this we aim to address. strengthning a continuum of care you see here. which aims to deliver services consistents with the person's as we call and you see at the bottom of the slide stage. change. on the right side looking at the bottom line stage of change as action or maintenance.

folks interested in the moment and making change in substance use or other health behaviors and maintenance refers to people who have achieved those change and maintaining them often referred to being in recovery. and you can see botch on the continuum of care, that we offer treatment services to folks in action or maintenance phases suchs residential, out patient treatment. medication treatment. sober living environments. on the other side of that continuum first calling your attention to the bottom line. precondition temmrigz >> this refers to folks who might be using substances and not really thinking about making a change. those are some of the 90% of people with the substance use not currently in care. and important low, don't perceive the need or foal they

need care. how do we approach those folks clinically, systemically, we offer engagement services both to prevenn them from dying in the moment, keep them alive in order we work with them to increase mote vision for change. some of those services include over dose prevention, syringe access cites moving long this to counseling for people who might want to make a change temperature is important to set the stage like this because in measuring or aiming to measure need and gaps we know we need to attends to people across that continuum of behavior change and offer services in a time low fashion that can meet their needs and move them along the change continuum

>> how many with substance use disorder access service in our health network d ph funded or directly run clinics. we see among san francisco health network in 2021. the number of people we know about in the san francisco health network numbers about 11,000. and the number who received a subsubstance use disorder service is 40%. should i pause. >> yea. if you can pause. supervisor melgar has a question. jul want to do this. the question on the slide you had about the numbers is this individuals or is it visits? >> meaning. >> an individual has several of those? i'm sorry the number of people, people. >> those are number diagnosed. >> yes.

>> thank you. >> and should i continue i'm happy to continue to take questions as you -- might make sense to hold them. >> got it i'm -- accumulating my own. >> next slide. the next slide illustrates the substance use services in san francisco where we deliver care and services. and present thanksgiving slide because we often think of substance use treatment as one thing. which is residential treatment. and that's where everyone stops their thinking. you see, on this slide of multiple tiles there are multiple locations for the deliver of sud treatment as well as risk reduction and harm reduction services. you see the cites of delivery. >> additionally, in those cites

we deliver multiple services in combination and independently. we deliver psychosocial, individual and group counseling. contingencey management. cognitive behavior therapy. medication treatments or interventions. then other service which support people moving through habehavior change continuum. assessment linkage and service and a halvinggation. housing support and deliver prevention related services to youth. funds from this following sources see them listed here from general city funds to federal and state dollars. et cetera . next slide.

describing on this slide the treatment capacity and service that are available in san francisco. i want to call and this was the subject of last year's conversation in part, call you were attention to the fact we are delivering substance use related treatment and other service in when we call the special care system. meaning the it behavioral aretha and increaseingly other sectors you see toward the bottom san francisco health network primary care. whole person intgritted care and community partner and prevention and out reach.

wee look at occupancy rates. what you notice is only the residential programs because that is the easiest to measure in terms how full they are at different point in time. this past year was complicated because of covid and sometimes losing staff or out ill. sometimes having to shrink capacity. you see there the occupancy rate of different types of services and we aim for them to be in the full to get people this and out in a timely fashion. next shows additional kiensd of residential care or place based care not included in our formal treatment on demand but

intendsed care for people with substance use out of a variety of levels of severity. you see some of those additional capacities there. next slide. the listing kind of service including community access. and other medication, which is for alcohol use disorder, contingencey management. expanded distribution including a new expanded work taken on by d ph. and treat over dose response teams started a year ago. >> all of these services contribute to the upon continuum

of care andune are serving folks who may be at a contemp lative or prep phase and in the red or interested or even needing of more formal or residential care settings. >> i want to present to you -- 2 graphs one is our treatment admissions through 2021. these are admissions to left lanesed treatment programs. and when you will see here, is that there has been a decrease in treatment admissions we talked about this left year for a number of different reasons. covid, back a few years ago with transition to med kale and standard who is is eligible for residential treatment. some of the folks needing housing were not eligible for formal treatment and important

low -- we are increaseingly offering low barrier and lower threshold care and care cross multiple sector this is is illustrated boy this slide unique clients receiving in san francisco. it is also goes by the trade name sabox one treats opioid disorder. you see an increasing number on the dotted line on the bottom increasing number of patients by year. these are data from the state so we can't over lap them with our systems of care. but this reflects an over all approach in treatment and getting people treatment in i time low fashion in multiple settings you see well is a more than 3 fold increase in the last

decade. finally or -- using our data and we are improving our ability to measure timeliness of care determined wait timeers time lilyness of killer in formal treatment programs. and management we found less then and there i day wait time to admission. over all -- 90 day residential, methadone program of less then and there a day with capacity. i want to point out this does in the reflect timeliness to access of other care settings we are increase to improve primary care and street based care and so forth.

i know this area is we, this is our data to the best of our ability to measure it. we do engage with stake holders and get feedback and find ways to improve where there are exceptions or whether experiences or contrary to our data. i will end with the left 2 slides. next slide. i want to rerowel what i believe to be our major accomplishments in the left year. we taxicab new service at the minna project in collaboration with colleagues at ap d and soma rise. we were successful, we believe in incorporating spanish language service there. we have more work to do. we also have been aim to expand service for people with dual diagnose. we hear and than loud and clear. in some of our new services the minna project vicktory why's

accomplice we aimed include care for people with dual diagnoses and plan for additional beds. expanding residential step down and expect them to happen in this coming we're. and urn taking a hospital referral improve am project aim to decrease the length and gentleman of time with referral to accomplicement within 24 hours. >> in terms of gaps you know we completed this report and turn today in on february first. in the context of this report and data we saw a major gap in our ability to address over dose prevention aggressively as the crisis deserved. we released part of this gap assess am a plan includes the 4

areas you see below a gospel reducing fatal over dose. important low reduce the prosecute found racial disparities among african-americans and increase the people receiving medications for addiction boy 30% by 2025. thank you for the time. thank you. appreciate it. thank you for your presentation and your important work. supervisor mandelman. >> thank you for your inbulgesance to go more than 5 minutes but continuing is important and i imagine that is the longest we have. this morning. i do have questions about a few of the slides.

we can go become to in of them. and i think the first one -- i think it gets go back to the slide number 2. that's it. thank you. this gets at sometimes foals like we talk past each other in the treatment on demand. discussions and may be the flaw is in -- if there is i flaw in the original legislation or mai may be needs to be updated. you presented the statement the d. public health maintain free and low cost medical use abuse services and residential treatment with the upon demand for these services. which is vague. like, could mean who knows had

that means the report itself -- is a bit more upon demanding or the language in the legislation quoted is more approximate demanding. the demand measured by substance abecause slots plus the individuals seeking slots and the total number of treatment slots plus the number of individuals seek slots the city could be flexible in treatments. present's plan to mote the demand. it shall be reflect in the the city budget of the city and county shall in therous funding, staffing or substance treatment slots visible for as long as slots are filled or individuals seek slots. well is an idea in this

legislation if you are in san francisco and you want treatment we will grab you the minute you say you want it. i'm unclear from our treatment on demand report and your presentation if we are doing that. can have a conversation whether that is the most person thing. there are other ways if we started emphasizing success of programs over time catching people as they leave treatment. access to treatment if we got in support end of 90 days and sends them to the beginning of the line and do that a million times. that may be had not be the goal of our treatment policies. i'm not staying it is 25 years old it is the right thing. negz this than i had 26 years ago was what i described.

i wanted to invite you approximate we can look at slide 16. this is updated information and better then and there what is in the treatment of demand report. yes. the treatment on demand report in 22 used data from the prior fiscal year 2021. this reflect the past fiscal year, 2022. i'm sorry in the to have highlightd that. i would like to say thanks to our team, my team much feedback and conversation.

we have seen improve ams and pleased. >> through the chair to my colleague, can i finish with the slide. why okay. >> okay. so -- i guess this chart i want to understand about when we are saying. first is an improvement, which the whole system to be commended for this is great. with drawl management is less then and there a one day wait. i also heard we don't have -- is that the same as you forgive my lack of. >> deto being service. so i am urn the impression we have limited detox service on weekends: >> meaning admissions. >> like i'm red to need the program but and i don't want to foal i need someone to help me

it is saturday and i need help with this. and we can't help you until monday, i think. so that is in the the goal. there are and you know -- i want to appreciate when we all hear sing lawyer anecdotes and bad out come. meaning i ask for help and did in the get it. this is a bad outcome. i will >> i heard from providers not people >> fair enough. i will bring that become and look at the weekend versus week day admission rate our goal is it care for people weekday or weekend. >> okay. >> and we think we are doing -- we must be if this is trough. you can't access during the weekend, i'm curious hathat means >> i mean on average cross our

data it means asking for and receiving can happen on average or -- median within one day and the box to the right what we intend to share here is we are smoothing the bear dwroers get it or aim to smooth the barriers 81% of cline in our system to our knowledge are entering residential treatment via step of management or detox this enabled us to get together which we talked about the last hearing the medical context barriers and prefers to keep people safe. tb tests, for example. happen in the context all management services and get them in residential efficient low as possible. >> and explain the 4 days that

are there now. is those issues we think? >> it is first of all, you have the box over eighty-one % of the folks we have them in a detox program and processing them. >> yes. why i guess question is. those are better then and there the treatment on demand report, is this functional treatment on demand. >> because if we achieved that that would be reflect in the your next report and no need my demanding of this gentleman's analysis and budgetary resources will you don't need that because we are providing treatment on demand. >> i think weep still have misses. meaning i hear stories, providers issue pishts and clines and we want to min moiz those. >> you think than i are

anecdotal. >> for the data i have this we have we are in the pick them up except in key areas we know we need more dual diagnose treatments. we know we need i will go back and look i'm getting tests some -- management available on weekends we go become and look at that. i think i want to reflect on the slide which was a little conceptual about the continuum of services as well as the slide that said many people who have a substance use disorder don't want treatment at that moment. to me the treatment on demand and the continuum of services is to pull more people in care. had issure goal. we want to convince, reach, give people when they are needing and asking for at the moment and that to mow is on demand

continuum of service. many folks iingly say one limitation of residential treatment. we want to press this down further. i don't want it rest on that. i want to ini have all of us, you, to think about that 90% of people from initial data and we don't have local data who have i substance use disorder and pull them in care n. san francisco healing network we are doing better that is -- of the people we know about 39 percent are getting a substance use service. wore better then and there the 10 but that 60% of potential low untreed substance use disorders are people we should aim to reach. in some sense treatment on demand i believe as you know i was not here, arose from a place

where substance use services this is trough now were less ouied low available and the upon richness and diversity of props were in the so available. and we understood that we should be treeing anyone had raises their hands quickly, that's the spirit of immediately the treatment on the demand. and i say all the folks we are trying to address healing needs save lives at risk for over dose. who might not raise hands for treatment that , is had we are aim to reach aggressively. >> i have more questions i would like to give my clothes a chance to weigh in. supervisor melgar. >> thank you, chair mar. doctor, what you go back to

slide 16. there was something about it did in the make sense and i wanted you to clarify. >> so so, can you explain like that continuum this you talked about. so. someone you know -- who is in the 3s of substance abuse disorder and who will want to do with drawl management first. for which there are only 58 beds but less then and there a day to get into. how long does this last? >> i think there is variability. i'm phoning a friend here y. 1 to 5 days. 5 day system like the max or you know the average. what's the next step.

is this the 90 day after this or is it people are out on the street? i'm trying to figure out like what is the relationship between those 3 things and are there other things miss nothing this continuum it make sure that you know people are successful. my colleagues, are we measuring the right things. is success the right measurement rather than like time it takes someone to be in treatment. is well you know yours in which we are this are more. way miss which the continuum works more conducive to success for example, if somebody goes to with drawl management and does in the get in residential treatment or has no accomplice to go or out in a neighborhood the habit is supported. i need to understand the

relationship between these things. >> thank you for this question. and i think these are 3 service types. i will repeat. emphasize 3 service types for which we because of the upon ebb row way, we have timeliness metrics available. getting in to for example, receiving -- someone is hospitalized and has an opioid addiction. may be they are hospitalized for a skin infection than i could get started in the hospital. they get induced and they can be referred perhaps to a special care setting. like opioid treatment programful referred to proirm care. could be referred to our own office space induction center.

had is a conversation with the person, the patient. here are options for you. here are -- advantages and disadvantage of each one and because we don't have a single way to measure that access. team's goal in the hospital to get them in care quickly. but those other system don't have wait times. i think the other issue is from with drawl management in the all substances require managing your with drawl. you can do it as an out patient with counseling. what is when we see here in san francisco is obviously, a high prevalence or rate of homelessness or people experience being homelessness and the substance use. those folks may benefit from a residential setting, they don't have a stable environment to be in. somebody is in the has a house

or home. able to make appointments they may need out patient treatment or support. i human is know unsatisfying answer. it is why it matters that trained clinicians doing this work to help figure had out and not a single linear path. joy get that. i'm not dissatisfied with the answer i want to understand it. we are investigate a lot in the system. i wonder. way that you describeis there is individuals choice and things have work different low for different people and i get that is there like a culture or social worker or somebody who tracks the success of that person wherever path they take

witness they have taken that first step weather it it is getting treatment. you know at the hospital or wherever it is the wuk in or is there then someone who keeps in touch with them and follows their process through whatever pregnant they take. why so, one of the features of our office of coordinated care you have likely heard about in the context of mhsf to establish care management teams for people at risk or transitioning from one level of care to another and at risk for not making to the next step and available to electronic and support retention and care. all of our programs that are medical funded and others are reporting to us things like

retention in care. shorter term they do better longer term. rep tension in care is a major outcome. we track we can see this in our data is when people drop out of care. strength happeningning our data system when is there are high risk folks i mentioned the office of coordinated care. we are intending it be ail to track this through our own back and data systems to appoint earlier what else and know retention and care and longer term out come really matter. of >> just to clarify. somebody who is a dp heart attack employee who acts as a case manager in tracking common regardless of what provider than i go to and what pregnant they

take. you issue seek to collect this data. wherey we are doing of the first for select. we don't have capacity to do it for everybody. we are intend to do this from back and dast using data to find folk hos may have dropped out of care to try to get them become in care. i will mention 2 other navigation care management role s the programs one of the the program is to support contract the programs to disorder navigator important low suggesting again prosecute meeting retention. helping the service

novembergation and ouzing or employment. and serve as enrich care management in the treatment program. >> thank you. supervisor stefani. thank you chair mar. on not the slides the treatment on demand report on page 2. it is explain third degree in 2016 california expanded drug medical and benefits under the 1115 medicaid waiver to bring improved substance use to california sector program. which permitted california to develop a drug medical organized delivery system restructured county serves as a managed care

plan rather than fee for service. when you electric to the slide 14. treatment if 2015 to 21, noticed that there is a significant drop in the number of e missions to programs disorders. based on whatever substance someone is seeking recovery from. i wonder if that has anything to do with that -- over to medical in 2015. we do continuing does and by creating a structure to evaluate medical necessity. some number were people were entering in our systems of care. not because they are substance use disorder met criteria but in

need of an accomplice to be a house. i should add that medical necessity under cal aim which is the medical reform efforts happening state wide has again -- reluxuried some of the criteria for medical necessity. and may well be that that is again changing. let me make a second point, which is trough in my own experience in new york, is that the residential system of care at times stand in for a housing problem. and we think to some extent this is had the medical shifts engendered. and -- confirming that.

yes. >> okay. >> and let mow add a point that i'm just -- i'm joined boy clothes i should tell you who are supporting me. we also are aware this people prior to medical to ods a number of people we serve friday out of county. and so -- they are required under medical now to get care in their own county since ods the managed care plan requires san francisco residency. we think that, that also like low drove part of the drop off. >> thank you for that. that is good information. if we can get the numbers on that break down if they are available. >> we will look, great question. >> yea that would slain a lot. and i wanted to we are talking

about treatment on demand there is a continuum of treatment for substance use disorder temperature is grit in san francisco we have many treatments and that people can access them. one of my on going questions is focusing on the quality of services we provide. because it is in the enough to say we have this many on page 3 on the treatment of demand report we have -- 36cbo's to provide treatment services and programs so this contract with. obviously it is in the cbo's we are doing additional substance treatment through program and service in dp heart attack primary care and street base programs. focusing on the quality of those services and whether or not they are measuring success. and the efficacies of what we

have asked them to do i don't know this we are coming up with good answers based on when we have seen in the news. service auditor report i mentioned at the board of supervisors and then -- i looked to with the medical in 2016, it set up programs for the state and the state to evaluate when d ph is doing. when concerned mow is this in march of thissier the state d. health care services found compliance issues with respect to compliance with requirements of the drug medical organized delivery system. you know i visited many of the programs myself and interviews people who work at the different programs and you know anecdotally we hear different things. it appear as compared to 2 years prior the county performance

based on hai read deteriorated and in the improved. what concerns mow the county has not requested technical assistance. my questions are around -- the reports coming from the state. and in 2022 be, the state found the coordination of care plan did not provide evidence demonstrating beneficiaries had access to support after discharge or upon completion of acute stay. and i'm wondering as a county when are we dog to ensure we can correct for this deficiency? let me say, for -- what happen in the process of our evaluation is the state contracts with -- external body to do over all assess am and evaluation.

we do well on many metrics and feel proud of that and work closely with the state. going become to the earlier question about -- improves working on performance improvement and quality. part of what the state requires and we want to do is a vire of performance improvement projects preselected approved by the state. and choose areas of focus every year including the work i mentioned about hospital discharge was an x. from the year prior and saw improvement i will also attribute our admission to residential care to

last year part of the performance improvement. i will -- let me supervisor, look in this question about recovery supports. because i -- i think that -- we had additional feedback and ways to improve i will get become to you on that. >> and i will mention another source. programs are required to report multiple out come and those performance measures are available and lengthy website. thank you i did want to point out the deficiencies i am concerned b. i think it plays into whether we provide

treatment on demand. one is the timely access >> reporter:s the other is the necessary training required for those working at cbo's. findings that the plan did in the provide evidence dem triing san francisco received the 5 hours of continuing education. says that a couple times and then00 autoplan did in the provide evidence staff employed by san francisco. i want to make sour woeful follow all the rules. staffing shortages that you know for many reasons expensive to live here. are we paying enough. there are staffing shortages difficult on provide the

necessary service. i want to understand if we are found in the state of noun cam pliance by the state what is at risk? i will say i share your klimt and desire to have high quality services delivers. >> i know you do. as -- i understand historically there are always areas for improvement when the state visits us. we submit plans that describe our plan to remedy deefficiency and we can get you those plans. i think in general are reports from the state over all positive. i stat sat in the visits myself in which we got great feedback

about the innovation, the breath. the seriousness of prop in san francisco. compares to counties about when we are doing. it is always important as we look at the outside feedback to incorporate that and there is opportunity for improve am. i don't think i think it is fir we are not in a serious risk this is part of standard -- you know part of the standard appraisal by state and we are incorporating feedback. i had a question about slide number 6. trying to understand the --

figures around looks like a significant can decline in the number had received a substance abuse disorder in 2020. in religion to the -- surge in drug over dose death in our city. had been grappling watch let me talk you through the dast a. the top line number of people with substance use disorder folks seen in the san francisco health network. hospital, emergency department of primary and special care. that decline or increase d denominator reflects that over all number.

what i want it focus on and our care system. does not account for all low threshold care it it is in part driven by covid in 2020 a decline in people coming in care for nonurgent or other folks who stayed away from care because they were afraid and services at times were less availability. 2020 is a hard year and into 2021 because of covid. that said i want to call when i think is important about this slide. . among people no one to the health net w with a diagnose what proportion are we able to

get in some sort of substance use that is a measure of our reach of pulling people in needed care who we know about. etch benefit am how will do we reach them. i think the top numbers are hard to interpret in the context of covid i don't see them as i see them in that context. i have a few more question and thank you for -- your patience and for sticking with us. for the others we are not putting you through a similarly long exchange with our other presenters. and do want to get to public

comment soon. but -- doctor, i have one more question about -- to ask to you explain. on slide 17. [speak fast] explain what that improve am project was about. what that you know what would you were improve friday what, you know. or do you not want to try. you know it is good but -- [laughter]. i'm going to call on my colleague who is directly involved with the project for detail busy our improvement there. is this was a project to make things better we have been hearing from the hospital this sometime its takes awhile for

female get to the hospital and get treatment. we shortened the assessments needed and were successful in stream lining. this was a pilot. and you see the 200 or so cases we were able to get through in 18 months this has been incorporate in the our standard operations including office of court nayed care. we have a service, the best team. i forgot what that stems from the best team and moves people around the system and continuing this again as part of mental health san francisco. they may come in for broken

ankles. were drinking and need treatment or substance related, infection. they need to go to treatment. it is expensive to stay in the hospital and want them move to appropriate services >> prior how long were you -- no, it has been varied. longer, i don't have a measure. when you have the multiple step processes we try to simplify. this is our objective. >> you know how many patients are not getting placed within 24 hours of referel. >> there were some therapy not appropriate referrals. some that were referred needed medical care. we developed a system than i go to medical res spit programs or skilled nursing facilities. others had mental health disorders i can't give a number.

we had to do sorting of the referrals i have a large group the 1s that needed substance use, we got them through in 24 hours. okay. sounds like it could be very good. thank you. one of our bright spots we hope to continue. >> now i'm bringing the doctor back. so i have been think burglar this hearing having -- 2 sets of question in my head. one is are we meeting the original -- understanding of treatment on demand from 1996? it might be and i have a feeling that others who will testify

they will agree but. based on slide 16, it seems like that might be pretty darned close. this is not necessarily consistent with everything i'm hearing from providers, patients -- you know folks in criminal justice system. them does not look terrible. difficulty is, if it is anecdotal. if these nshs right and not friction. we are meeting the 96 treatment on demand and our work is don that and we can go to the 2022 set of questions around treatment on demand. might be the sonia sotomayor. but what does it mean today? in 1996, i'm imagining the number of people who were

seeking treatment who were housed was probably higher. relative to the number seeking treatment unhoused. there is a whole set of challenge this is may flow from this. a different set now in terms of um -- the programs were different. programs lasted longer in general in 96 then and there they do today. so -- it is possible that there is a whole set of questions we should asking today not just about the friction on the front end but when we are doing for people this is what supervisor melgar was getting at. there are different steps long the way. if we are people on the sort of congratulationses you knead through your 90 day program and we don't have anything more for you so -- good luck.

i know that the department has done some work to try to address that. there motorbike a set around a connected base odz number of unhoused people throughout programs. we need a certain number of step down bed if we maintain sobriety over time. and a certain number of co-op you know living situations or we are -- i don't know it gets harder. i'm a little i recognize if we sends you off to chase after every data point approximate measure there is a cost. there is a cost to and also a cost of doing things without know when you are doing or getting for it and pifor a lot of substance use treatment for people who may get relief. but machine that is a disheartning prospect someone who has been on that hamster wheel more than once.

i want to give you one more time. i have trouble believing we need treatment on demand, we will hear from people today we are not. we will ask the people from the criminal justice system how challenging to get right treatment for your folks. and they will say, very. may be things are not bad but helpful to know when is the freakin gap and how do you think about that and is there a way to xhoukt that so we get before we get to the 2022 version of treatment on demand like to be think through the 96 version. >> so that was a chunky question. reference to supreme court. >> do this in 2 parts.

do the areas where you acknowledging treatment on demand do not measure well is a gap there is a gap for people spanish language speakers. a gap with dual diagnose and gap for people who are in the criminal justice system. how dot gaps fit in the chart and how do we think about if those other only real systemic accomplices there are gentlemans how do we think about closing them. i don't want to gloss overnight frictions. i think i don't know what everyone will say today. i don't money to minimize the accomplices with continue

frictions. i think you order from the doctor where we need to smooth steps and make it less bureaucratic orb administrative hurdles. there are service or tailored services we need more. measure over all whether we try to present here and less structures and set them and up hear from my colleagues in probation today about ways we have tried to aim to have common data and electric at things together. we have more work to do. there are some system this is are harder to measure. i thank you for acknowledging the process of put nothing structures to measure. i concur we need to measure

>> need to know impact and tried do this better and better since in obviously in the department and within behavioral health. there will be things for data protection issues and scyllo of the substance treatment system from other data because of federal confidentiality preservations. there are real data challenges we have. and so not measured we don't have capacity approximate minot get it. i think there are things we need to continue to work on and i'm committed to do this and we are committed >> i think you are right. there is ways to improve on the measures of the stuff we are now and i think that and thinking about the yours that are touched

on in the report not analyzed grit to get that. in the next report. for the sonia sotomayor 22, the things we might think about measuring going forward it seems like it is the accomplices where we lose people beyond the initial demand. i don't know if you have thoughts. this is where, we talked about doing manage with left year and this year's and we didn't. i do feel the kinds of calls out for additional information that you gather or required to gather each year this measures something and i you don't have to figure it out now. the effort to not lose people once they are in the door. >> i money i want to just -- i appreciate the 1996 versus now.

1996, there was no treatment. it was in the until the 2,000 report in the medical association this described addiction as a chronic illness and we need to think about it different low. we need to have shorter term and longerer term supports. recovery supports, peer supports and so forth. we can tree people successful low in other than residential settings. we learned so much since 1996. and yet i will say, treat funding and organization of a treatment system remains scylloed for many reasons, funding, stigma. separation of who does a and b. and we are i'm very proud and part of why i signed up to be in san francisco, proud of the work

that has been happening here for years to push down the scyllos. in the nature treatment on demand and creating low threshold care. and it is helping and i try to highlight in the slide in thes different place. and all of that looks to deliver services that are can have the with how we understand. substance use and addiction in 2022. including long-term supports and retention and care, long-term, critical importance of housing stability and maintaining and achieving recovery. all of that we know and i let mow i like to think about how we might represent them and when we measure and report out. >> i think measuring the electric of like the next what impact not having the next

place. how much of a shortage we have. and how big of a problem that is. >> i will say, with some amount of i want to leave you with the attention that we are we have more to implement with mental health sf. and including 70 residential treatment beds as an example including dual diagnose beds. we are building i know you know this. why without a great sense of what the gap is. with some sense of when the gentleman is and as you know and we talked about we are intending to do another we are calling bed opt miization study part of the sector with a contractor. and upon hope to do that sign think am answer some of this. >> 2 more. i money they are big questions.

>> this chart again shows looks like needing treatment and a staffing crisis among providers what is -- we have is it the can is we have a staffing crisis that is significant cannot enough even when we think we have beds we don't have as many because there is in staffing for them i believe to be the case. how does this relate to the numbers about access to treatment. i think again these are meant to be sumtive numbers. there are time this is we have delayed admission and intake to care because of staffing shortages. this, i think is we think is both a covid impact or in times i mentioned and because of critical workforce shortages

that also affect our be ability to expand. including our own behavioral healing access center where we were delay in the expanding hours because of hiring challenges and i know these hiring challenges to be affecting all the services in the city. >> and last is to what extent you think that situation at baker is going to impact our ability to provide treatment? >> so, as you know and we are really concern body the situation there. our top priority is to ensure contyou inity for people in service there and continuity of services and volume of services

for the city. we are working very hard to achieve that goal and closely with baker. >> all right. thank you. thank you. >> next up i believe we have chief and possible low steve and destiny from adult probation. >> good morning. and thank you member of the board for inviting us to the hearing. i'm [inaudible] i am the chief of adult prosecute bachlgz i was not [inaudible] when presented at the hearing. my background is i'm a first generation latina former high school drop out. i'm the first african-american chief for the department and been here for 23 years. adult probation is a national model in the community supervision andent row

innovative props that we take to balance social work, social justice and law enforcement. our sworn and nonsworn staff mirror the community we serve am including staff that have been to prison and or in recovery and leadership positions helping to defined policies. the per inships we have helped us to achieve our mission to helping people restore their lives. i'm so proud to introduce 2 of my staffents row service manage [inaudible] and our director offent row division steve [inaudible] they are extraordinary. take it away. >> thank you, chief. hi, everyone. good morning chair mar, supervisor mandelman and stefani

and melgar. as it is chief mentioned i'm steve director of the am division for adult probation. i will touch on points about our work. some impact and turn it over to destiny who will take you through our treatment efforts left year. and we will circle back with our objectives for next year. my team has 3 primary roles will. we design, implement and manage reent row promise. manage the re7 row council and community corrections. and we notoriety process of designing service for women building up the women's community blueprint developed by [inaudible] blom. highlights from fiscal 21-22. top priorities to reduce jail population. we took a bold prop recovery and well expense advance racial equity. we all the abjectives with

supervisor safai, steph no and others. the positive directions the trp academy. billie halt day sxernt minna project. 68% of professional searchs everservice contracters community lead organizations. last year invested 15.4 million dollars in reentry service around 33% of our budget. served close to 2700 undub indicated. andor departments return rate was 3%. you know this is low. so, our work is unique. serves are unique. all of our programs are designed to meet the needs of people in the justice system. needs are fact nors a person's

life and related recidivism. you will see 8 factors that national research identified as factors related to crime. through our reent row treatment net w a portfolio of programs, affording multiplent row find in thes system of care and no gap in services are existing. clienting enter on one end. . addiction that might be homeless enter the novembergation center and the extreme right an therapeutic teaching community people are not on substance. i am excited to announce we will issue a report soon. and excited share impact from last year. across our 55 reentry programs serve the 2700 people . reent row center managed by

university of california san francisco, over 2400 people accessed service including clinical reentry characteristic medication, 1 on one therapy, employment retention service, vocational training. support groups, mentoring, and other events we host our 17 drug and alcohol three free residents 've. daily base house 450 adults including people on probation. last year they housed 896 people. [inaudible] collectively saved

471 thousand dollars. and 132 participates were placed in permanent housing. i will turn it over to destiny will walk you through treatment efforts and circumstantial will become with objectives for next year. >> in 2018 we got our feet wet in recovery path ways initiative. incentivized residential treatment guaranteeing up to 2 years of housing for those completing a program. >> we are excited offer that treatment to begin with stabilizes our housing program. the san francisco probation department funds 2 treatment service. we were able to serve 215, we had 215 enrollments. the first one on reent row ucsf

an out parent program. served 83 people and acsisz is immediate. where we saw improvement you see is work at light's program. >> there we fund 5 detox beds. and refer ferals were constant 21-22 the average time to get in dropped from 49 days to 6 days. we credit improvement for another a number of reasons. first relationship with the department of public health is stronger than ever. cut through processes and get in people in treatment faster by funding an intake coordinator on sight. which stream lined the process.

and then next to add to that work we started offering covid and tb tests. further eliminating barriers to treatment and cutting access. we have a number of upon wins we would loic to share. last year the adult probation mitigate the challenges. first the bill halt day center services to people p homelessness including exiting the jail andent row point in our system of care and january and june the center for 251 people 65% exited in to therapeutic residents issue licensed drug treatment or permanent housing.

as a result of organizing by the working group. we were able to launch the directions academy. a therapeutic teaching community. in per inship with public health launched a 75 bed transificational housing program with clinical services. we also. to note incredible wins we had to highlight is our per inship with soma rise has been a huge asset to justice. our community partners ewe likewising the site and it it is prove to be the city's first step for treatment on demand. we hosted our remember of light event honors those we lost to over dose. incredible is it strengthened

the rust community members to work together toward a goal of draegsz the over dose crisis. and as our chief mentioned, we are extremely fortunate to have leadership by individuals who have gone to prison, over come challenges and are in position which can affect change. my division director and victoria are resent row policy planner were grateful to have them. as far as challenges. we know there is so much work to be done. part of this, we want to urge city partners to expand solutions and incorporate strategies to help people struggling with, diction we need honest conversations about open air drug scenes and the empictures they have on lives struggling with addiction, children and the greater

community at large. one factor we hear is that housing is a substitute for treatment. and we all agree on the importance of housing getting people off the streets and how crist dam is to care drus drug use is causing problems treatment should be the primary goal. the leadership of chief and with our commune partners we have been on a campaign to change the narrative we believe adult probation people over come. reclaim place in community and achief dreams and have an opportunity to be a productive system. i want to acknowledge the work of supervisor safai and stefani getting trp bill holiday and the

minna project funded. [inaudible]. >> thank you. i want to highlight our partnership with department of public health. doctor reminded me it was a year ago we were here with our group out. and it is nice to see in san francisco that people can have a difference of opinion and come together to form solutions. the only reason the minna project came to life was a couple. so one, we a chief mobelieved in our work and able to build relationships with city hall. the baptist of public health stepped up. 75 unit build and people have not stein got all private bedrooms and 4300 square feet of community spachls on site nurse that is clinicians on site and

really is upon supporting people that did not do well in traditional licensed drug treatment programs. thank you and i will go on to our next steps. first we have been working on research project. destiny, myself and the council director service subcommittee. we will be issuing it to supervisor stefani who is a member of the reentry council in the next month should be complete. a mixed method research project analysis. it's got rich information we held focus groups a survey that went out to 300 some odd people. we are looking forward to that. and discussing what is at the root of the needs of people in the justice system. sect low, supervisor stefani again. a couple years ago held a

hearing recovery summit working group. a group of men and women who over come addiction. got together story nothing 2018 and created a platform of recommendations to improve out come for adult in san francisco everything from safe consumption sites to hard core programs and everything in between. it was inclusive and looking forward to this conversation in the near future. we will continue to acid vocate to establish drug and column he stabilization centers andment to upon expand service for spanish speakers. it is really challenging. there are so men now this don't have property services and so we will continue to fight for the -- anybody got questions we are here. >> thank you.

thank you very much. chief and also steve and destiny for the updates and encouraging to hear about the improvement in your cline's access services and the now initiatives you created and thanks to supervisor stefani for her work. clothes do you have questions? >> sproirs machine man. >> i don't in the interest of time i don't have questions i want to thank you for your work and help to see being able to work together and generating good results. it seems. so good work and with that bring up the treatment on demand coalition.

i will stfrment i'm laura i'm the senior director of hiv and harm reduction policy and treatment on demand coalition. >> i'm sarah short with home rise and member of the mental health sf implementation working group. i will tell you a bit about our coalition and hand it to laura for the presentation. you can go to the next slide. so the treatment on demand coalition is comprised of a broad group of community

organizations and individuals this . is a list of our key folks. call out a few. the network. look nothing here -- senior and disability action. point being, these are community groups from across the city who serve a variety of different folks. who are all interested in the issue of making sure that people have access to treatment. community organizations and service providers. look to rim prove act sesz every point in san francisco. and we are watchdogging around the proposition t treatment on

demand, which softened the law in 200ave and that is a dpraim framework to see are we meeting the goals and what needs to happen to better allow people to access treatment if than i need or want temperature i will hand it over to will you evera to tell you about our thoughts on this issue >> thank you supervisors for having us and thank you to supervisor mandelman and jackie thornhill and staff for your tireless work on this. in terms of the system of care and our take, we believe san francisco needs and serves a more upon expectancyive accessible and effective continuum of care people using drugs and people with diagnose and substance use disorder and people in recovery.

san francisco has a good care and there are people when fall through the cracks whether they are unable to access services and find services. vulnerable to over dose to criminalization to stigma in our system of care. next slide. some of the barriers this we are aware of from our side on the community and provider up front. one is staffing this has been mentioned. we don't have pay equity across the system of care. we appreciate the d. public health has done impress of work to hire up in their behave health system we want to be clear that come from those of us in the nonprofit sector lost a lot of very kwul foiled staff or higher paying fissions in

department of public health. i don't begrudge my former clothes. highway light there are people in front line out reach and often called peer positions who are not paid devolve what their expertise simple you heard about medical assessments and wit times. and the uneven access to services we may not have enough dual diagnose. minot have enough services for populations. we just at the san francisco aids foundation and national harm reduction coalition did an assessment of latin x community needs focussing on spanish and mya speaking and found gap in services and just a lack of awareness what service were available. won't want to highlight the

needs for those communities. and -- you know just this mentioned the closure and cut becomes at bake are places, i think covid hit a lot of organizations hard and figuring occupant how as a city we can continue to uphold essential service and make sure they continue. regardsless of the provider and how we can keep service afloat. this goes to another supervisor mandelman's occurrence around board and care. laguna honda is part of this. how do we keep the parts of the system together and housing. it is a large driver of so many problems. next slide, and this again and again thank you to supervisor mandelman for highlighting this. ask questions about how we

measure demand. people have been desuede friday accessing service by bonjour rattic criteria and no longer measured part of the demand for service. they stillment and need and deserve service. are we asking the right questions. when is never showing up at the door. whether because of language issues or documentation status. because of dual diagnose mental health and housing issues. people accessing treatment and not comis i problem of our system of care. had we are not offering the right services to meet their needs. and we would not accept this in primary care setting and should not in this setting. ensuring we are keeping an eye on racial disparities and how we measure them and the access and

out come. and need to ensure that when we are doing across the city is in the in any place making the problems worse. not creating solving one and creating another. way in which we may criminalize people or increasing stigma on people that make it hard to access services or leave them with additional willing charges that they make it hard to access these services. here our recommendations. one, this is -- mental health sf was created to address much of these occurrence. we have the parallel processes of mental health sf and treatment on demand. we got this work group tinlded look at a lot of the questions. measuring the things. developing solutions and

identifying gaps. makes no stones have separate efforts when we have one that city over all -- concern. and with this, i want to highlight that you know thank in part to city attorney chiou and state attorney general there are funds coming to san francisco much come with >> reporter:s that it used to mitigate opioid use disorder. i think the time has come for you to have a community process around this. whether through meantsal health sf which is set up to allocate funding or credit a new process. there needs to be a community conversation how the funds are used and identify the priorities for using them. >> we also recognize that we need more low threshold service this is help people move into

the residential treatment of care. we need to provide over dose prevention services and surprises consumption service as a part of the programs keeping people alive so they don't die of over dose and they are able to achieve recovery or other goals. and also those services as anent row point. highlighting ways that we keep programs open. you know detox and joe heely has been an e terrible open with management has been an essentialent row point in the system's care for so many we can't ford to lose that. services continue to be informed. hrm reduction and evidenced based. workforce development issue is

really, really essential as we are losing staff to other better funded positions. we need to create a pipeline of workers coming into the field and -- that also needs to be inclusive of people who use drugs and in recovery and people who have access to the services and have expertise. in that. and yea. in general, we want the city to continue to focus ensuring that everyone who would like treatment is able to. achieve treatment and focus that before we figure out how to push others in the care. we need to make sure we are addressing all the people who are as doctor ascertain said with hand up saying we want care. we are very appreciative of doctor leadership. i think the enormous improvement

on treatment on demand report and level of detail and transparency is a reflection on her leadership and commitment to this. so we are enthusiastic about continuing to per in with public health and achieve thanksgiving. i will stop there and see if there are questions. >> thank you very much. laura and sarah supervisor mandelman? >> thank you, chair mar. a few. there is -- there is -- laura suggesting, a bit of attention but there is -- mental healing sf looking at the questions and issues. on one lane and the treatment on demand conversation we reverified on another lane.

they are related but not exactly the same. and in this area and others, i'm not sure that the folding everything in mental health sf gets us where we want. >> i don't know i'm asking for thoughts on does it make sense to have this separate conversation about treatment on demand or folding them in the mental health sf work? >> i am certainly not suggesting you stop your oversight. i think this you supervisor mandelman calling these hearings brought a lot of information and focus and attention to this issue. and i'm appreciative of this. i knowledge the board of supervisors to continue to play that sxroel asking these questions. and in learning per the board supervisor system per of the solution.

in terms of your function over seeing the budget and where fundings guess. sarah on the working group there is no one (s in how they measure the questions are they america the same things. i think that both processes account benefit from having the conversation together. what are the things they are measuring? how do they identify gap in service? what are their priors for funding? the same as the 1s that you would come out of this hearing with? >> at the time this law was passed, we were scyllo in the terms we had substance and mental health they were separate forms of treatment and service.

now it is about behavioral health. it is intgrit in the terms how the d. public health views it. et cetera, and so i think however we do it it does make sense to better integrate the work we do around substance use treatment with mental health treatment services and look at it as more of an integrated component than separate. >> can i get you to talk about when i almost a -- factual question butt like do we have treatment on demand in the 19 nic or 2008 sense or not? i mean are we -- the approximate suspicion of d ph seems to be we are pretty much there. there is a need to tinker and anecdotal things that go wrong.

i will ask criminal yesterday to come up when i hear from that world is, no. but -- may be not. may be we'll hear today this things are peach and he you can access. >> i think purchase of this goes become to the measurement issue and the way we measure. won't don't know. the other thans it your question. will you ever laura pointed out this we are not measuring necessary low all of the people who are out there who want or are seeking ready for treatment. we are not hit thanksgiving universe. so -- we don't know. >> got in come how long it to being them to get in. >> i think that we can say -- i told you the members of the coalition and just in conversations with those providers and organizations and this we are not there.

there is work and will you evera please add anything you know more. >> the problem minot be with the treatment on demand as the upon demand. when we know is this there are a lot of people who have access to treatment. they have access treatment multiple times and they have left for their reasons and -- that's an inindictment pedestrian system in the the individuals. if i were go to kieztory access proirm care and tree me bad low and stopped going. does this mobile home i don't need the health care or this provider will not mote my needs? we need i think it it is evident that there are people in san francisco who would benefit from at the minimum access to effective evidenced based substance use treatment. and benefit from mental health services and likely benefit from

housing. and they are not necessary low showingum in the demand numbers. they are in the walk nothing our program and saying i want treatment. and for mean many of them than i accessed treatment before. did in the mote their needs. they will in the go become to a system that treed them body low and not met needs before this is part of my concern is that i think that the d. public health is accurate had they talk about this is the number of people showing up and the number of bed and how long people wait. but you know just -- you know san francisco aids upon foundation we get people this for group and drop in groups but when they support intensive counciling and need is this we have a wait list. we are keeping them in the drop in support groups until we get them to the counseling is this

unmet demand or is it not? those other measure am questions j. how does this get talked about in mental health sf conversations? is this part of -- i'm thinking over the i would now fired up to go and get people talking about what questions do we 92ed to answering how should we change what the reports look like in the future so we ask questions. is the work group asking these questions. we are look at capacity issues and things like that. i would not say we are taking a

deep dive in the big question of -- what is the universe of people out there who need and want care and are not receiving it. supervisor stefani has -- >> thank you supervisor mandelman and sarah and will you evera. i just on page 2, slide 4 i want to clarify our system of care and those seek care. you say people who use drug and people with substance use disorder. and i'm wondering, people who use drugs to the extent they need care from our system of care, are they separate from those who have an addiction or sud? somebody had uses drug little

not benefit dependence or diagnosable substance use disorder men vulnerable to over dose. y somebody using cocaine in a nonproblem way but vulnerable to an over dose. there are harps that come to people who use drugs inclusive of acquiring hiv from sharing indekz jection equipment. how do we ensure they get health needs met and staying alive and don't progress combo a substance use disorder and our system can meet their health care needs. speem start with nonproblem use.

the minority that develop it and meet the diagnose criteria, those other folks we focus on in the services. we want to ensure that people who use drugs may encounter health harms are served by continuum of care. do we have a percentage of those using drug in this way who need help or nar can or -- whatever fentanyl slipped in their cocaine. houck using drugs needing help are in the a problem. a percentage of this? >> i'm not aware locally. at the national level there are estimates. the mate is that around 10 to 15% of any drug.

cocaine. alcohol has a higher %. tobacco the highest % of people who use it who develop dependent. ooem not an addiction doctor and i know there are a couple of medical doctors behind me who might have better estimates. usually 10 to 15% develop problem use. >> do you think fent until can be ouz in the a nonproblematic way. it is a pharmaceutical product it is used in anesthesia and farm suital fentanyl is used in a medical context. fentanyl itself is not yes, it is a pharmaceutical product when

we talk about on tree street is illegal prowse exclude can be used some try it, not for mow. don't do it again they feel have not developed a problem they decides thshg is not for me. it it is opioid and the path way to dependence and addiction and substance use disorder i like to defer to the addiction doctors. i mean i imagine boy the time someone is they are not using drug in a problematic way and i know the difference with fentanyl and that sold on the street. fentanyl sold now is so deadly. 50 to 100 times more deadly than heroin. i'm by time someone is getting

at this time point they buy fent until in the tenderloin from a drug dealer it is a problem. >> you know inspect my opinion. if there a risk of oding this seems to be a problem. >> that's not the medical criteria. but it does make people vulnerable for over dose. >> thank you. the other thing you mentioned was people are desuede friday accessing service. i'm wondering, too, and here is where sometimes i think there are issues in competition. around the types of services we offer. and i'm wondering if interest time that people don't access a level of services they may need. and what i mean by that is there are many reasons of why people

don't seek the mr. president a substance abuse disorder. they are unissue wear of problem. it warrantied help. they don't know how to live without alcohol or drugs they cannot imagine mag a day what that would be like and how they go of. ay farewayed to fail. some believe they want don't deserve help baseod low self e steam issues that come with the disorder. denial. denial is a huge part of the disease of addiction. people don'ting they can't ford it we are trying to make sure that is not the case in san

francisco. we near no way each person is very different. they -- as you know i don't have to explain that. i want to make sure in our desire to treat we recognize that each person needs a different level of care. and up to us to make sure that we are not intrefr with our biases about had that care may be. to make sure they get when they need. and i just get nervous about where we may stop with the careo might not push further f. machine is in the tenderloin and

you seen the videos. they are suffering and the only care we seem to give them is how to use safely, which is good. we are not there to push them and say your life will be better this person got better no one thought but he d. i feel we need to make sure that we are -- not desueding people from receiving all care. we all know addicts are stilling in typed. people are aprid to give up alcohol than i don't want people to say, why do you drink.

they are afraid to give up drugs the same reason. we have to be careful about stilling in typing about recovery if this person wants to tell person how grit it hen for them and than i, to, can give it up and machine wants to be on methadone, grit and this working for them. we cannot stigmatize people's recovery choice. i think we need to do better about this in san francisco. >> thank you. that is well said. >> i wanted thank laura and sarah and the treatment on demand for your important w on these issues. i proernlt the points you made around the need to measure demand more then and there just the number of people or

percentage enroll nothing services. this relates to the question i asked the doctor on the slide she had that showed that looks like we are from the san francisco healing network 40% of folks able to access treatment that is add moirable compared to, ecstasy. i was puzzled by the drop off. it was felony to 16% decline in number of people accessing service fist 20 then to 2020 to 2021. i was wondering if you had ideas on how we being better evaluate demand and -- looking ahead to future prop t supports? >> i think, 2020 was a watershed year. because of covid, and so many things changed. you know, um -- treatment

promise had to change. how they operated. we set up shelter in place hotels in san francisco and struggling to figure out thou bring treatment to peep in holings. 2020 every measure possible went up or down. and so many were not accessing heck service at all or -- you know staff were out sick. you know, i think its -- 2020 will be a year with an asterisk on it in every possible measure going forward. i don't want to make conconclusions about chinks from 20 then to 2020 without tick thanksgiving in, count and covid and the -- comma in isolation really you know affected a lot

of people's relationship to substance. often in negative way and i think men of us turn to subsubstances to manage trauma and isolation. substance use within up and others within down. people's recovery was affected others found recovery. it is a challenging year to draw conclusions aside from covid happened. and i think as we move forward figure out what it it is, you know that we need to measure here, it will be key and what is happening around substance use in the city as a whole and what is happen with treatment with treatment continuum. i appreciate doctor showed i slide that had the continuum of services and the continuum of how people move through it.

of precontemplation, et cetera. electricing and try to put numbers on different place in it, may give us a sense of where we are in terms of when are our prevention needs. how do we keep people from moving forward in progression of illness and provide the right level of intensity of services for people so they achieve goals including recovery. not sure that was the answer. people are not going to make interests known if they are in the aware of how and where and by what means they request treatment. and i think there is a lot of people out there who may be ready and may desire treatment but don't have the information about where to go or begin up because everybody tells them it

is impossible. i knowledge dog a good effort at out reach and education. and actual surveying to people out there -- if we want accuracy. i are thank you, so, i -- really appreciated something this you said earlier about the number how we upon count how well we do with treatment on demand. and we are not capturing folk who is need it but had prior negative experiences and don't want to go back because they don't being needses are met n.

aggregate numbers presented by everyone, you know we did not seat nuance in race issue gender or house hold composition. i wonder if you have data or thoughts about that. i can see how you know a pregnant woman or woman with small children you know has options that are more limited in terms of the treatments that they are willing to go into and separate friday children or. you know or a black man. and in terms of the way they are treated or perceived. i don't have number. there have been research in

sudden front that looks at piece of this. you know the researchers from uc stshgs f. doctor crawl. people who have been doing research or time looking at the broader set of people who use drug and what services they acsxesz when they don't. i know that we had a consensus -- process that was estimating the number of people who inject drug in sudden front. but i think the numbers are out dated at this point given how fast people are switching to smoking. i think there are ways but involves difference researchers and -- folks so no, i don't have this did the but help to try to

figure out withhold be good to get. >> you have thoughts. >> and you know san francisco aids foundation and national harm reduction coalition completed the survey of lettin x community we would love to present to you looking at spanish speaking and myan speakers and barriers to care. and really were not arare of a lot of the service that were out there and so -- we love to present this to you at some point. do you have thought busy it. i think substance use can look very different for woman than men and transand visiting more so part behalf we know helps

people skeet. for people wo don't have community or family support it is harder for people to achieve goals these other supports through aa or your people are available in helping people sustain recovery. acknowledging this people who like lgbt folks minot have contact with family or folks substance use created -- rut sure in their family relationships. how do we help rescue noise this is created more trauma and help them recover the relationships.

thank you and welreach out we should think about -- treatments on demand for the 21st century. that might be different from 96 and 2008. >> thank you. >> okay. we have to get to public comment. i also to dig in the question a bit of access treatment for justice involved folks and so i think we have representatives from pretry and public defend and district attorney's office.

hello. imented giveut town to border patrol to address ease of access for treatment for people in pretrial. a quick over view. so -- commune organization in the justice system. serve 7,000 clointss an iary the daily case load is 1800 anded vs the highest level at historic high of 850. for reference clines that are referred to us by the courts. so we take everyone that is referred to us. we are unique, we have a city wide client base. we have people across all levels of structure in san francisco.

so we have a diverse client base and supervisor stefani comments we upgrade position we meet people where they are and connect them with service they need. we are time limited we have people on case loads while in the pretrial phase. there is urgency around connecting people to service quickly so they have an on going relationship witness they leave. a quick over vow for context. i don't want to get the points you brought upon the piece about contracting be cbo and the ease of work nothing the city system and compete with the city related to cost of doing business increases. for example wore excited see our city cernel part and school teach and things are getting

increases. we get cola increases year to year they are sporadic. it is heard to budget and plan there is a challenge on retaining staff and making sure all of us have enough people to meet the demands of folks that need treatment that is an important point. another important point is around people who have accessed serve in the past that have bad experience. and i'm thankful that now we are looking at the same relationship with d ph and office of coordinated care this is something we have been talking about for years. we start to mirror that rep with jail healing once people are

relieved they come in the community system and electric how we build a stronger network of collaboration with our agency and d ph. we are not a city agency that puts us outside of their network and don't have the ability to access information the piece about people whom have accessed care in the past. clients released we pick them and up begin the treatment plan and depend on the civil report information to develop a treatment plan and appropriate interventions. we use harm reduction, treatment, services and neat clients where they are. if a cloints does not self report and had a bad intrns we

may sends them become to the agency. and there we burn a bridge with the client and trust in rep building we sent them to a service this fail in the the past and the service does not help them when they get clines that don't want to access that agency and this happens. but tightening up this relationship will be critical special help us move forward. i had our staff electric at the recommendations in the treatment on demand report. universal low they all greed that time from admissions critical improving treatment for spanish clients and culturaly appropriate service. improving the flow for justice clients. and low threshold treatment

service are critical. i would say that the treatment that our clients need is not always available. it is improving but there are challenges through our discharge planning. people are released all times of day. and we don't have the ability to connect them with service right away. a weekend and that's a lot of time that is lost and gaining connection tot support than i need. role time access is critical. there are challenges and again serve a speck rum of clients so some of this is anecdotal and the challenges we face are the fact this clinicians have to make referrals to per in agencies and wheres we have 2 clinicians on staff, with a case of 850 intense clines not every

approximate [inaudible] for the refer ferals how do we set up a system case manager can access the networks and again hoping that is addressed through the new d ph rep. and then -- in general, it is just a what has been said is important. tightedning up the relationship with d ph are important we appreciate the time they invest in the build thanksgiving relationship. office coordinated care is xoiting. we are hope to take advantage of [inaudible] this will be a great resource. those resources are shifted for justice involved clients. the birth picture this treatment piece is a critical part of the over all public safety everyone everefforts san francisco needs a strategy and a plan we can all

follow with transparency and accountability built in we know if we hit our out come. treatment is one piece of a birth safety plan that is something that is critical to support public safety and folks that need treatment. >> thank you. i want to ask, a quick question how many people did pretrial diversion refer to treatment left year? >> we don't this data we hope that with this new partnership d ph and data match system we will track that close low. du say case managers can't refer people to providers. >> difficult about this. this is something i dig in further but there are certain electronics where clinicians are

have to make referrals and case managers can't i was not able to follow the staff person i surveyed the staff can get more if helpful >> this sounds very suspect to me if you get mow that information your case managers have trouble referring people to treatment that would be great and numbers how many pretrial refers to drug treatment. thanks. >> thank you supervisor stefani and thank you mr. moore. may be more focused with the public defend exert da if i just am trying to drill sdound like the pretrial present agdz they are having challenges access for example people leaving the jails. i would be specialed in this a

bit. for people in jails or courts were or involved if start with the public defelonier hear if you believe we have treatment on demand or what challenges you are seeing and how you are working on them. how this is all going. do we have the public defender here? >> hello. good morning, thank you for thg having me here today. i'm a reentry social worker at public defender's office our office a member of treatment of demand since 2017. [inaudible] serves on the coalition and she is unable to present today or provide know

comment, i'm here. beg your pardon lovers in social work and served in the fold for 10 years. born and raise in the san francisco where i lived my entire life am every week our unit connects clines to treatment service in thes city. and we work with clines at all stages of their case from emotions to pretrial sentencing, post conviction and connect them to treatment programs across san francisco. the reality is both clients are criminalized busy their disorders or mental health or both. we see that inoccurserated clointss accessing treatment while incarcerate exclude than i don't have many treatment options. report from 2020-21 there are insufficient access to treatment

on demand services and [inaudible] to clines is the lack of language accessible and culturaly competent community based treatment options in addition to electric of sufficient hrm reduction, low threshold and [inaudible] and transgender and nan conforming specific options. there is one in patient substance use program for monolingual spanish speakers. and the latina commission with 12 beds this is a great program high retention and great graduation rates. the wait times for besd are long. and there is also one dual diagnose program for spanish speaking clients. which is [inaudible]. this requires paperwork and interview and wit tim for a bed.

one of my social worker colleagues referred incarcerated clines to both programs and she found the referral press from starting the paperwork to the time the client is accepted can take 2-3 months. and my clothes and i have conversations with the clines about their treatment options and some okay to go to the newer program catharsis [inaudible] they express than ied want and need a small trauma in patient program this provide the threshold harm reduction services. in addition, my colleagues found this although some meet criteria for out patient programs than i are not always easy to enter. and treatment programs of all types have longer wait times do you to the pandemic and staff shortage or limed bed capacity.

the wait time electric of servicesh service lead to decompensation and others lose hope and the determine out of treatment while wait nothing custody. some recommendations social work team would like to offer as people who work with public defend are clients looking for treatment. improve access to treatment on demand. prioritize the support individual in recovery especially those encarserated or systems involved. we urge to you address the barriers placed by the city's public health department create cust for people seek access to treatment. they are delayed for the following 3 reasons. one, d ph require a packet submitted leads to longer times to drill a cline from get nothing a program and they are send nothing medical issues that

put up road blocks to treatment. 3. if people can dual diagnose striebs medications this limits their program options. our clines would benefit from expansion. low threshold drop in programs it is known in the public helling comment the trauma exposure increases risk the developing substance use disorders and mental health symptoms. lack of funding for hrm reduction services which include nasal [inaudible]. as well as transificational housing. we ask to you keep people out of the criminal justice system. community members with disorders or ment will health needs should

not be neglect exclude subscombrekted trauma in jails we need to fund intervention and service provideers and incentives to increase the workforce of biling william social workers. and need increasedk sesz it supportive housing. thank you. i'm happy to answer questions. i would like to call the district attorney's office. >> thank you. supervisor machine man for experience thanksgiving hear and for your leadership in the spitz for people in the community and the criminal justice system. and thank you chair mar and supervisor steph no and melgar for you attention to our needs and comments today. i'm suzanne the managing

attorney for the collaboratetive courts for the sudden front district attorney office under attorney jenkins. 17 year veteran of the office and spent the majority of my time work nothing this court space. 9 year assigned behavioral health court. here in the city. and -- first i want to associate our office with many comments made before by treatment on demand and from our clothe miss this public dem fender office the need for different treatment lower barrier treatment before than i come in the criminal justice system. change in the way once they near jail we need an examination of work to reduce the friction

points that we encounter the clinicians encounter this d ph koirnts woo had we get people from custody in assessment and a treatment facility in the community. the public defender mentioned up to two months for people might have focusod drug court. we found it is 3 and sick months to get people in i residential facility this is necessary to treat needs and the people this we work with the population we find to be incarcerated and needing treatment it is dual diagnose. and so who i we appreciate the fact and grateful for the fact barriers reduced by the department of public health to substance use treatment in the community, that does in the meet any way or form the needs that the people that we encounter in the system have. it helps to deal with people in our drug court. primary low that is their issue.

but as the public defender noted people may present with this issue but have other significant behavioral healing needs. their needs will not be met. not able to exit the system successful low and the safely in the community without adequate, available dual diagnose treatment that really meets the needs. i know we are short on time i will try to feel upon be clear about the things i gisment to i have 4 talk points first, increased victim in the clinical staff resources we have in the jail behavioral healing system. second we need system change in this system to enable to assess people and reif he ever them to the treatments they need. that will require the support of the city from the board. i than my clothes and jail

behavioral healing service are working collaborative low with the other system per ins the whichever's department and included to track the time and wait data for time and wait time and map the referral press and the place am press to identify the friction pointses exist friday beginning of time. and have not gotten better. it is at this point where months are added to the aim of time it takes to get people tr coming in custody to get them out in accomplice am. that something that we really implore you to give resources to. and support to d ph and the per norse figure out how we e eliminate the barriers. >> also, see -- we need to

expand the diversity of treatment optionless. i know drushth was talking about doing this there has been progress made. but not enough for us. we are -- strategyly feel we need resources for people that are in need of more gender affirming treatments that includes jen gender residential treatment for women. and for trans identified people. they have needs different from what the mainstream need in our community. ad sxushgs more and more adu like facilities for people exiting custody and headed residential facilities. the wait time that happens once people get accepted than i are

witting for the bed and they are wait nothing custody to get treatment in the communitiful it would be helpful approximate increase just and welfare for people to get out of custody as soon as possible and go to an accomplice not their ultimate first ultmitt stop but where they can continue to detox and stabilize and be fully red to take advantage of treatment once this bed is red that would be useful and personal addition to be funded by the city. we need facilities and step down facilities and continued case management this will support successful transifications from this residential treatment bed. achieved to supportive how doing in the community and their own how doing in the community. address thats-ster wheel issue

the board has been talking about from the beginning of the hearing. and supervisor mandelman talked about accomplices we lose people in treatment on demand. criminal justice system is the biggest place where we lose people. because we are not proid vlog the treatment this is necessary for people to get well, to cease behavior that brought them in the system. and live peacefully with health in the community. i then and there we are short of time. i can stop there for the moment. actually before stop i echo the need for there to be change under the medical research now one of gwen from the beginning of time the barrier has been

people are require topped receive treatment in the county of resident. we have people from other counties getting arrested with criminal activity and we are faced with hudo we get them treatment. people are required to be residents of san francisco before than i get the treatment. and it would be good for everyone if people could get the treatment where they lived and so we trongly encourage the city to take advantage of the cal aim situation had we find ourselves in. to -- throughout justice specific planning effort to change the requirements related medical restrictions this excloud a person from anticipation in our collaborative court treatment based programs. treatment on demand for justice involved population policy and planning efforts this is e eliminate bear dwroers treatments accompliceod

residency. it is our the da's obligation under the constitution to protected public safety. it is the obligation of all public official in california. we cannot accomplish that -- duty that goal of public safety using treatment when we do not have necessary and adequate options for people. and so we want a change and lessning incars rigz a change in focus but we never achieve it until we have a public health system prosecute voids for people's health from the beginning who i incarcerate exclude after they leave the system. i'm happy to answer questions. >> supervisor stefani. >> thank you. can you provide the wish list of

when would it take to achieve what you were speaking of so we know like what are we lacking what we need to advocate for. the programs you need. thank you for bring up the medical change what other programs do we need. can you send it later. it would be noise to have a list of had we are lacking >> happy to do this. i would focus on working in a 5 minuteses from now work with jail behavioral helling and our system per ins on that huge number of friction points there are getting people from custody to the bed. we don't have the beds necessary for them but also that the time that people are spent waiting to get to the beds this are do exist, is long and not through desire or effort -- of any system partner everybody is dog their best but it is in the

working, how many beds this would be working y. i will talk to them. >> thank you. why thank you. >> supervisor mandelman. thank you, as always for your insights. it does just seem to me -- people should not have to get enengaged with the criminaling justice system to get the care and treatment they need on the other hand, sometimes the criminal justice system given the relative weakness of our public health tools is the only opportunity or best opportunity to intervocabulary in someone's life. and i know from approximate talking to and you others in the world and the jail behavioral health, we miss opportunity every day. there are people pass through jails who are would be eligible if we had the appropriate bed

and people who if we get them in the right dual diagnose program on day one instead of day 90 that would make a municipaling difference and the chances of being successful go up and the cost to the city would go down. it seems wlr incorporate treatment of command or through mental helling sf or another frame. getting the steel the point where we mack myself that moment when a person's healing issues lead to a criminal justice problem which we loop back into the right health response and change the course is when we should aim at. does in the feel like we are doing as much as we being or

should be. thank you for your work >> on that point would be helpful that even you are right sometimes people get arrest exclude get in the system and they get help. helpful to everyone if at that point we could identify supervisor steph no's question the we have the resources we need to refer this person to and perhaps achieve a diversion this we do -- have some degree of now but in the enough to keep people from coming further in the system. i agree with you. thank you. . i'm here on behalf chief scott.

chair mar, vice chair stefani and sproirs mefor and machine man. thank you for including the police department in this personal discussion. we appreciate the opportunity to present to you the work that the men and women in sudden front at the police department are doing every dame i want to give a quick look in this action in regard to medical service sudden front police department responded to assist other city partners and on calls required [inaudible] activated and required the police department to responded. [inaudible] since 2019, the sudden front police department has responded to 8, 356 calls. moneying that ems activated through 911 and also the san

francisco police department was dispatch do you to the nature of the call. so in 2019 responded 2, 499, 2020 responds to 2, 07. 2021, 1, 960 and 2022, 1, 830. with the total of 8, 356. i know supervisor stefani asked about nar can i collected the data and how officers have deloyal since 2018. in 2018, deplayed 78 times, 2019, 135 times. 2020, 213 times. 2021, 145 times. in 2022, 123 times.

our officers responded the calls saved 695 lives. will briefly i like to highlight barriers we see. the supervisor [inaudible] crisis and prevenning team. per of my duties i dot trin and supervisor the field unit this respondeds to people in crisis. homes, vehicles [inaudible] or structure where public safety concern has been risen. some of the barriers i see is connecting the individuals to treatment. will right after we spends 7 hours with them negotiating for them to come out of what barricade position they are in. talking to family member. i will talk a bit i want to you give you the experience the

officers have every day. when we respond it calls we deal with the person in crisis but we are dealing with the family in crisis. so we have to navigate the events at the same time and i know sometimes gets emotional and i'm passionate about the topic i see the suffering of loved ones. i see the suffering of the people are sprngs the crisis. it is hard for you to detach if this. we say we will get them to treatment. we'll get connected with and linked to service. just to find out that responsible become on the streets did not get care they needed. there are a number of reasons why. i share with you how revolving door for yous. our goal as a police officer is to go and assist and protect life and connect people to

treatment. i'm proud to say 99% of the times we responded to calless does not involve the use of force from our officers i say that we have the numbers to prove that. my intentions and the men and women this work for the police department is sect people to treatment. gives the sense of discretion when you want to come and you meat promises to people you will get the loved 1s to treatment. i like your occurrence everybody had here. i worked with c skrshgs s and we all have the same concerns we are not getting the necessary facilities to receive treatment.

diagnose is the biggest challenge. 50% of the people we deal with mental health, suffering from dual diagnose. mental illness and will we plush the chemicals out of system but not the layers to the organic part of ill know employing

gatory is focusing and folks here they know. you are in the field. on perhaps our provider of treatment upon services and in san francisco you and i and talked about i think this goes to what treatment mean in 2022 versus in 96. the importance of step down facility and i wonder if you can talk about what the need is for this. and how you see the current state of the world opposed to the need. this is a challenge for some time now.

hay need the people around them that help support them recovery after that 90 days. we have step down residential programs and they are key and they allow for another up to 2 years of having that support and independent and freedom. and so i think that -- in our experience we have a number of beds there are not enough this program allows folks able to do a personal development, do more

things to support themselves. and often time folks are able to access when ladder of housing we have in san francisco. where it can be you know a subsidy or housing after that or a room mate situation. market raid rent. and so i think there is something to be said the experience of step down residential housing. >> we have a few handle. why right j. we have a couple handled. >> yes. >> and i think ideally we want 3-4 times the amount residential beds we have and step down. >> i'm struck by the we did memoryium for form are sheriff's son died of an over dose in an sro in the tenderloin.

and the model of -- housing that puts people in permanent housing unit in thes tenderloin the language term plan for your life. well is an accomplice for this and need some of those but it foals like we have under invested in the sort of temp rare places to land after completing a treatment program might help you novemberigate and have you with other people in who are also on that journal and he getting support and figuring out where is your life going? >> right and participating in out patient programs as well long this way. i say my health right 360 capacity aside, it is frightening someone in a program and 90 day program and you don't know where you will be at the end of the 9 days.

trying to figure out, ploying and hoping that you are lucky enough to guest in to manage you can continue your recovery and sobriety. and often times folks are become where than i came from. we should open up to public comment i want to thank my colleagues for your questions and engage am and allowing you to have a very long hearing i apologize i have a 1 p.m. i will watch the public comment that come in as will my legislative aid and thank you very much, everyone. >> thank you supervisor mandelman. >> why don't we go to public comment y. member who is would like to comment for item one line up on the wall. remote members dial story 3 to be added to the queue. on hold continue to wait until the system indicated you have been unmuted.

you may prop the podium. >> i'm livesa i'm a prodigy of treatment on demandful working with behavioral healing service in 2016. my inquiry began in 20 prison and 20 felony after the medicare and medical and the cuts in 2012 and 2047. piwant to bring to your attention i sent a sunshine ordinance task force a request for case management to cline centered care on all sectors of our mental health from the shelters, novembergation up to the sro's. all of the contracts with dpa and behavioral health service this is hen pushed under the rug for 5 years. i gone through 4 clerks.

rules the task force the data given to me. veronica bane left. and now it has been controllers and no data. the response from the department public hen is no did thea on file. my question is how are we funding this where is the continuum of care? the warm hand offs? the shortage of staff? 1999 an hour is disturk. we don't have case management. we don't have clines centered killer how are you funding the programs with no data for the last since 2015.

thank you for hole thanksgiving it is know person topic and proeshged by community i'm david lewis a member of treatment on dma understand a former commissioner of behavioral health and serve as board of directors mentality health and work on the it mental healing working group advises the crisis vention team. i had a chance to see out system works and see how the system ws from the inside i'm a consumer

and in recovery in 2006 and walked city service it get criminal housing, back then i experienced something close to treatment on new england the this time. i got housing. took a year. iel. i got spicht how doing through community housing per inship. got treatment in a week of asking it was low threshold. did not some i th to come to it and wuk through the door and ask for help. i was not put you have this long. because of that i'm here today and survived i like others to survive. now in the tenderloin we have -- the lincoln center the tenderloin lincoln center do you to close due to lack of funding because of neighbor complaints.

>> good afternoon. thank you for this hearing. hearing number 3 on treatment on demand. so, i was much young are when treatment on demand was passed and on healing commission. i want to share with you how much i appreciate your hearing and i want it make a strong suggestion for when you have hearing 4. because we must continue. i'm happy we passed treatment on demand but i think we hit a

limit of when we were tinding then. i think there is some limits about still fighting over which modality when we should not be we need to work at another level. i think that this reporting today shows a limit of that original legislation. treatment on demand today requires another level of your over site, requires getting people who must collaborate rit together and problem solve together before they come and be accountable to you. for example if you had hsh here today we would be talking about quick are response. because today the housing supportive or other residential or whatever than i have to be a

per of the solution. than i need to work for a year at least and come and report to you with their collaborative improve ams you heard so men improvements when we started. than i are aulgsz in the scyllos with very few difference. there is cooperation, coordination, within the scyllos major achievement. linda chapman rather drill will dru on my experience when i worked for the army i went through training on substance ash buz diz ordered i had oversight of i program. one thing the idea people will walk am. that's wonderful when they do

but most the issue of the addiction is the people are novelty able to make those choices because of subsidiary stance changed the way the brain works. so, every opportunity has to be made, taken advantage to feel get people in treatment. if they recover from know over dose you save them. do you send them become to loyal on the street or at hotel. the city is the big of the enabler. hsh -- for example, you know letting people move in the hotels and paying nothing. the federal government when than i give benefits. that is supposed to go per housing. we used to have before they turnd that over to nonprofits

see that the person in does not get cash they get a small allowance. money goes to housing. another issue is -- is relapses. relapses are part of the recovery common law low and you can't put people out in the street because they have a relapse they need to be referred back in treatment of testing is important that's the way you discover and get people returned treatment. and i will come become and talk more about payees and others we used to have this and it worked.

>> you know we lost young folks to over dose in 2020 and i have i privilege of working with young people in clinical services and the front lines. i'm nought director of youth board and i get to hear what young leaders are looking for when they are looking for is care this meets needs of everybody and young people who have beds that are safe to go to. our young people are treefd go to treatment but not house in the treatment rooms with adult who is are 60. these are 18 year olds and 21 year olds can you imagine being 21 and asked to stay in a room with a 60 rear everyear old getting treatment we need beds for young people and wear care we have people who use

substances they need safety and nar can and harm reduction you know kits. we need treatment from that and need from in patient and deto being services. they want it all and they are open to it. but they have hit barriers. bureaucracy. i know someone mentioned the process of getting a cline in treatment. we have case manager who is can't fill out the piece of the work our clinicians are supporting the case managers. good afternoon. i'm to feel wolf a recovery advocate. so first all we greet on one thing medical is a barrier and we need to appeal to the state to expand treatment coverage for

up to sick months for people on medical. longer you are in treatment the better you do. another thing about fentanyl used that is false. i used elicit fentanyl it can not being used nonproblem atically it is for a short time and becomes i huge problem. there has been a 5,000 person determine people entering drug treatment in san francisco nobody wants to talk about it the fact that during this time we had over 2,000 drug over dose death in san francisco that impacted the population of people that would have access treatment. so -- that is another conversation we need to do more to mitigate the open drug scenes

and fentanyl flooding community and killing kids and families andim guarantees it is killing people of courteous. at the same time we need to expand all treatments this statute generational crisis. that we are facing with fentanyl. there are private organizations that are red to step in and add the beds the next 5 years. and we need to have --. i'm [inaudible] good afternoon.

supervisors. one thing i kept hearing was about treatment on demand meeting the needs. one thing about san francisco when we allowed happen is we allow use to happen if i'm allowed use in public spaces the way i like i will not access treatment. why would i? i will access use. >> i understands that -- you know -- that they are trying to meet the need where it is. the other side we need more alternatives that is the thing that needs to be supported.

racial disparity had it looks like is -- that we got people got work getting minimum wage to serve the same people they are. and they are a paycheck, way from being that same person when i see in this is this most of the money dps to either rent or paying for most of the money goes for people who have degrees and people who are distributing medications to individuals. the people that are dealing daily don't get paid anything. and everyone talking about a person and being -- i apologize.

2 minutes. >> thank you. >> hello supervisors i'm sheba a public pol manager at home rise in the city. i live in district 6 and w in district 5. the tenderloin. a member of the treatment on demand i appreciate this committee for synergy a hearing be around on demand access it treatment. it is important we raft in when works. what work system our access programs reduce diseases. 99 prevennes over dose deaths. drug checking programs and money onling william speaking community and investing in affordable housing to reduce the stilling in with open drug use

or open safe consumption sights. today there was over presentation of criminal justice departments i'm unclear how the departments are providing quality treatments to communities that isrousing harm in the community and the system. bipo

>> hello. i'm [inaudible] a resident of san francisco, good morning to y'all. i'm here volunteering with homeless coalithe and i wanted to you know urge more funding for the ment will health and substance abuse programs in the community. other than funding for the withins in jails men a good idea to put more funding in ones in the community so people get the proper help instead of sending

them to county yes, i wills and prisons. tree the patients thirty need different help and -- would be a good idea to help funding on the streets. thank you. >> hi. thank you so much for having in meeting i appreciate that because i have been already felony years dealing with that i have a son who suspect 40 years who have schizophrenia and suwhen he had to go through for him to get services and just to cap the last episode he was live nothing hrm reduck building. it did in the work the place was full of drugs. the people had sold drugs were

outside of the door so it was not the right thing for him. so he was -- okaying out and after spending time in jail he came out very anxiety row and would have rage episode. and i know suzanne christian -- because i begged her to give my son a better health and behavioral health and could not. she had to become up that went for months he could not get the help there. so00 autolast episode he was kicked out of corner house. when i went to court it was like a fact real there were men evictions in sudden front especially for somebody like him losing a house. it is horrible. the next thing hoe now went it helped 2 months ago. has been in 7 different

accomplices. whether it is -- let's see door. the hospital, hummingbird. all the accomplices but and eventual low finally -- in the hospital after i wrote a letter did in the have the information even he hen in general hospital men times hi to wroit a letter in the night. send an all right telling them when would in the last 8 months. >> thank you i'm jenny a primary care provide are works with ucsf. and i do appreciate this hearing. what i want it represent is this -- our system i have wed in

the system for the left 15 years and experienced this my patience have further fractured access to treatment when they need it. i wanted put out when we witnessed with now looking at closure or loss of bed system this as a city we have under invested. we hope third degree we could pay less for when is a simple low hard themming to do. we expect people to go home to westerly it is they live outside the city. and return to their 15-20 dollar an hour job in the city dog what is very difficult work and yes, yet, i see my patients are resilient and did make it through their tough street homelessness than i can leverage the services to their benefit. we need to fund them. take the system seriously. and commit to it as a city.

thank you very much. upon anyone else? mentes to peek in the chamber? we will move to the call line. there are 14 callers with 8 in the queue. forward the first caller. >> good afternoon. i'd like to lift all the recommendations shared during will you evera and sarah's presentation establishing the community press for allocating settle am funds. please invest in an evidence based continuum of care for prevention and treatment on dpanld extend effort its next criminalization, stilling in and

trauma this is a matter of survival. people cannot access treatment if than i died of an over dose. san francisco has an unmet need that we are sitting on the knowledge and capability to prevent over dose deaths and disparity in health out come. science behind low thresh hole services is emfateck. they are cost effective intervention. over prevention searchs implemented and to scale before dangerous low ill advised december closer of [inaudible] center. another critical component is the [inaudible] saves thousands of lives in the city but religion the life saving drug because of a shortage of supply.

thank you for your comments. next caller. >> good afternoon. chair mar and priorses mefor and stefani i'm carolyn ken doe a neighboring lead in district 8. thank you for hole thanksgiving hearing i'm encouraged by the wait time and [inaudible] reported upon [inaudible] and

also by discussion gap in process and resources and against collaboration. i want to reit rit 3 opportunity for improvement. first, everyone called the need for post treatment step down bed and programs. outcome based measure its guide where we need invest. identified a big town to collaborate rit more effectively to get those involved with the justice system in treatment as an alternative to incarceration. this cries out for i person upon centered prop to design. now the process you get people from where they are whether to diversion or whatever in a treatment program to get the people who are ready and [inaudible] everybody needs to take those down i sug revisit

this issue. oversight would help the organizations to collaborateerate effectively. i urge everyone to tree this disorder crisis the covid pandemic we have funds and will in the save live fist we wait until they are red to have know effective process, beds and programs and other things that are needed. thank you. next caller. next caller. we will come back.

supervisors, if is a shame you have this hearings. you are talk and talk and talk now 1. . 30 and allow us the community to talk and give us 2 millions and then interrupt. talking educated y'all because you don't know when you are doing. you irrelevant don't are treatment on demand in san francisco. you should be [inaudible] and y'all should be taken to court to have a hearing not why are y'all having the hearing you trumentize the people. every time you have this hearing you are [inaudible] wrap african-american services why are you traumaticizing the people of san francisco having the stupid hearings? and mandelman is in the there.

taking a vacation. and another one supervisor because brother or somebody mentally challenges talk and talk and talk. where are the solutions. stop investigate hearings we get traumaticized. thank you. >> thank you for your comments. forward the next caller. >> hi. good afternoon i'm paulina i would like to thank everybody for being on this hearing. i know it has been long but irrelevant good comments boy supervisor melgar, mandelman and steph no and questions as well. i know that we need treatment demand. i know this prop t requires us to have low crime and the proper capacity of besd but you in i know the wait time for a bed is

up it 47 days. i know this we need it mote people where than i are and the people need to have this access. people are dieing and i know that people have expressed a need for meeting people where they are it is in the happening and i really nose to see more progress here like everybody else does as well. you know, harm reduction, lower barriers to treatment. just getting people off the streets. and of course, not having jail be the first priority and option for people. thank you. next caller. i'm ellen grant a san francisco

resident of district 8. thank you for continuing the incredible sessions and everybody who put forth comments. i'd like to echo that the gaps is huge and so much demand notteen counted. when people show up to an appointment at better for intake they have been turned away there is in the staff. that responsible isn't being tracked. there are different experience we have and you heard from others this the gap is huge. beyond this, i wanted say, how frust is this with a shortage in treatment that you are fast

track the cites not once have you discussed the consequences that govern site when he vetoed s b 57. and they are irrelevant. we study this in detail and you can count on the cites attracting more deal and users. there are 7 not guilty queue. forward the next caller. good afternoon chair mar and mefor and steph no. i'm greg justin a residents of the tenderloin i support

organization addressing the needs of i community it relates to the subject merit in obtaining service and drug use and service needing to so bright. [inaudible] in support recommendations for treatment to demand of any effort to address a trsities of i nishgd will tick a per inship [inaudible] enough include the participation of all city agencies ensure most [inaudible] individuals prosecute voided with service in a time low american. we are discovering some services men visible we are following insure in a number of iaries. over half of those unhoused suffer from substance a because. shortage of beds. equal low the lack of workers on the community provide information regarding services considered treatment ready. october 16, few are then and

there 30 beds available to meet the needs of hundreds. data provided today is confusing and ask if it is accurate or providing the information is when we want to hear. and lack the community engage am not meaningful, treatment on demand in san francisco with the city funding the department of public health needs to extend treatment beds. thank you. next caller >> good afternoon supervisors. i want to just start out by thanking you for hold

thanksgiving personal hearing i'm a human right's organizer for the coalition on homelessness and member of treatment on demand. almost felony years since san francisco voted make treatment a prior and today we are asking our city it aboyd by the law. we urging the city for continuum of care butt city is content with the system that squanders resources and fails to meet the needs of low income community. there are barriers that gh addressed. access it shell and housing. lack of staff. and moreover the stigma many people of color face. people wait per days, weeks ownership months they may give up to treatment. we are here it call on san

francisco to follow through on the request for access to treatment. the support is crucial to ensure the physical, menial and e notional safety of community members in san francisco. thank you very much. >> thank you. there are 10 callers with 3 in the queue. can you forward the next caller. >> i'm donald grapes i live in district telephone i have been live nothing san francisco for approximately 24 years. and i seen the problems with drug use open drug use only going up. i have 2 comments. one is about the open drug use in our city and i think that um -- it is something this needs to be emphasized if you are a drug user in the city and you do

seek care, um, it would be hard to wuk around the streets of sudden fran without being exposed more drug use and drug sellers. i think we need to address the open drug use and selling in our city. as a parking lot of this treatment on demand. we need to eradicate temperature every time when i go to certain part was city i can see open drug use and drug selling every time and it is shocking we don't focus on the areas. my second point is that um -- am we are we put, let of money in our system of our health care system and i just echo the fact we need as many beds visible as

possible. um -- and we also need to focus on people who are not even able to state they need care. people who are in crisis, and they are a drug user but don't know they need to seek care. there are people who are walking around the street hallucinahall. >> thank you. forward the next caller. >> supervisors thank you for tick the time to have this hearing i'm jennifer reside in district 2. supervisor steph no's district. i echo the centiment from the earlier caller reduce the supply

in the open air drug moment i wuk and see people doing drug this is is in the good. and when people do drug its caused mental health problem. yesterday a video on twitter about a twe year old young woman who was healingy from santa rosa doing fence fentanyl in san francisco. i think the city must do something with providing more services and more beds to close the open air drug market because san francisco taxpayers cannot possible low fund all the people from outside the city seeking drugings in the city. i understand prosecute voiding access is person but we must reduce the supply and close the presence of the drug deal and practice cow them, too. thank you.

clear clear we are looking to see if there are additional. there are no additional speakers to the item. >> great, public comment is closed. i want to thank everyone for the xrem low person hearing on our annual report. the city's annual report on prop t and our treatment on demand goals. and thanks to the presenters, d ph and city departments and the community advocates that participated and continue it push united states to address this crisis. that's empeculiaring lives. thanks to the treatment on demand coalition, rescue sf. 360 and everyone. will do you have comments? >> i will move that we file this hearing. madam clerk?

>> thank you on the motion to file the hearing vice chair steph no. >> aye. >> member melgar. why aye. >> chair mar. why aye. why there are 3 aye's. >> this hearing is fileless. so we will adjourn and reconvene for special order later at 4 p.m. to hear our seck item it is hearing this spries melgar called on response and resources visible it students experiencing reporting sexual assault and harassament at sfusd schools >> welcome to the reconvened meeting of the public safety and

neighborhood service committee. on thursday, october 27, 2022. mar the chair approximate i'm joined by committee member megovern and vice chair stefani shortly. i want to note that this like we recessed our mote thanksgiving morning and until 4 p.m. today for this special item. special order item. thank you to the committee's clerk stefani cabrera for staffing and i like to thank matthew from sfgovtv and -- you need to dot announce ams again. >> good. >> madam clerk item 2. >> item 2 is a hear to discuss san francisco school district and city departments responses to increased student reports of

sexual assault and sexual harassment and vendor based violence at sfusd schools and collecting data pertaining to resources made available to students partnerships with sfusd or community based partners. promote safety and healthy environment in our school and sfusd to department of children use and families office of sexual harassment and assault response and prevention and the status of women to report. member when is wish to provide comment call 415-655-0001 then access code: 2486 793 5172 ##. police wait until the system indicates you have been unmuted and begin comment when is we go to public comment.

thank you, chair. >> thank you. i want to thank supervisor megovern and staff for experiencing and organizing this hearing. this is an important topic now and -- sexual harassment and violence impacting our young people including at our high schools has been a problem for many years. it is an that were is pushed to the surface more in the last few years because of inactions by students themselves. and as a father of a teen daughter and who is a senior in high school now i know the issues are personal to me as they are for you my clotheos the committee. thanks supervisor megovern for calling for this. the floor is yours. >> thank you chair mar. thank you both for your support in hold thanksgiving hearing 4 o'clock so the students could

payment. i'm proud we are here for this important discussion. i am the mother of 3 girl and it pains mow that we are having this discussion to address the prevalence of sexual and genteder based violence in schools. i'm proud to be partner with our youth and our youth advocates demonstrates fierce leadership. it was a year ago that students from every single public high school in our city marched to city hall to demand action on the sets of issues and to demand adults step up in address sxrns hear voices. the hearing is intended center the voices and experiences of students. who are also are conscientist wents. especially survirus of of sexual violence who brought this to our attention with courage and

leadership temperature is intended for us to listen and learn about the need this is remain unmet. i hope to deepen our understanding of how we, city and school district leadership serving youth through prevention and responses and identify what programs, services policy and procedures and professional development and training we need to enhance and what improvements are necessary. it is our responsibility to ensure we partner to leverage our resources to ensure we create safe environments for youth to thrive. i continue to be engaged with you and remain committed to responding to their call for action from us. the grownups and commission of leadership. i want to thank student who is show up and speak up to the survivors who shared stories to peer allis to up left and safe

spaces. with a goal of creating solutions i want to thank the city agencies and staff for being here today and for your commitment to work toward solutions. i am now going to turn it over to our presenters. we have a number today chair mar i hope we can hold off questions until the end unless there is a clarification. we are going to start entering the voices of students and we will start with the student representative isabella hansen joining us on teams and -- both are student delegates of the board of education who will set the context for today's hearing. isabella on teams and cal is present so woman.

thank you, can you hear me? welcome. >> i apologize for background noise i'm at school. i'm isabella hansen a student delegate on the board of education. throughout my years the most notable problems sexual violence in schools. push reforming title 9.

the campus horly after to november second of 2021 limpations include [inaudible]. for example. you see on the posters on the right and in the middle 6 figures rebelicate title 9 can protect you from. >> hold on do we have her slides? are they up.

if you see the examples include a section fading title 9 violation is not a sexual joke about a pier. others are title 9 violations not stopping on an occasion and sexual will assault at a nonschool event. association with the wellness team and drive home the message [inaudible] district or anyone involved in schools that survivors sit next to abuse and not granted justice for title 9 victim blaming and had to be taken down by students. >> the walk out lead to a walk out and others at schools and cull monnayed in a protest.

educate and prevent sexual harassment that occur in schools. expect today change and policies [inaudible] directed toward survivors. [inaudible] the district ensure every student understood limitations sfusd has and survivors granted justice due to title 9 policy. the group was enactd and conversations were started. no real change was seen in survivor production in abusers and support system for those impacted by sexual vinyls. a list of demands stating that creation of the support system for survirus a reporting press of incident and information.

uninitial we have yes to see a few impelemented at schools. given all this context it is important to discuss sfusd's response to the issuesor electric thereof. throughout last year's protest add administrators stifled student voices removing posters. shutting clubs approximate intimidating students. some went so far to threat tone have the police remove student fist they protest in a basketball game.

we want to give credit where credit is do and create a student group and approving the proposed reforms. mandating the sexual assault and sexual harassment are investigated under the title 9 and sfusd bully policy have 2 thresholds for identifying will sexual assault and as a result. we have fourth to go. a couple more, please. >> am thank you.

>> making tiling 9 informing accessible putting up pesters and digital information out the big issue we identified is survivor unaware of rights and recording processes. secondly, the same lines creating prepared list of resources to provide survivors when they o'riordan incident. third, audit health curriculum consent education for verbal and physical interaction is in elementary not just high school. because we believe this in order to create a safer learning environment in the future we need focus on prevention and education at a young age. mandating wuk on coaches for school sports go through the statement professional development trainings as employees. a man dori accept near and wifr

this all student athletes try out for sports team. inform regard to the left 2 demand its is important to acknowledge the rape culture in the athletic department of allegations of grooming by coaching and directors insensitive comments boy coaches one coach said in regards to assault the past is in the past. quoting esa from frozen. and majority of 6 ulviolence last year were against student athletes. correlation does in the equal causation and we do not wish to improve being a student athlete makes you prone to sexual violence this enough of an issue where we feel targeted intervention is necessary. the left thing the board of education governors changes, approved changes including pausing all resolutionless and

making board policy amendment this is may not be a problem but it statutory historically the council's only means of legislative change to offer a resolution that be coexperienced boy a board of education member. and this is what we hopeed do with the title 9 resolution from left year. >> our problem is in the with pausing resolution it loyals with the fact that we have not been giving meaningful alternatives to create legislative change and isabella and i assume the best intention and don't think this action was intentional we highlight stripping us the power to pass resolutions without giving an avenue to propose changes student voices have been stifled and students have lost their legislative power. student voices are not only important than i are essential and must be include we urge the board to help us understand how we propose policy changes with

the got changes. >> thank you, cal. [applause]. make the announcement in dam clerk? >> board policy we ask you oddable forms of support if you are in wave your heavy if anything and if you don't thumb's down. thank you. >> that is not indicative of nonsupport i obviously support we want to keep it quiet. so now we have hong may pang interim head of communication and external affairs at sfusd. and williams executive director of office of employee relations at sfusd. who will present on the district policies, procedures and the on going work to address the issue of sexual harassment and sexual

assault incidents. welcome. >> thank you. [laughter]. good upon afternoon. committee chair mar. vice chair stefani and supervisor melgar. i want it thank you supervisor melgar for calling for this important hear and inviting us to pip in this discussion and dialogue. i want to take this opportunity to thank our student delegates cal and also hansen for presentation and the many student leaders for their upon continued leadership to champion student voice. social justice and also to really help present what the recommendations are toward a solution's driven prop. first thing i want to say is sfusd wants all students to know that their concerns and you know increases are taken seriously. we support our student in taking action to address issues.

concern to them across any your. every day we work with our principal and other school leaders ensure they are supported in allowing city councils to exercise free speech. sfusd addressing the concerns they suffers in men ways i appreciated student delegates acknowledgment around the work we have been doing in per inship. my colleague williams the executive director of office equity joins mow to share the ways her office addresses the occurrence and also how we have been work to meet the demands with students to improve policy procedures. you should have received recommended reading materials in advance provides an over view of sfusd work in this areinasm i want to read in the record that on october lefrn of 22, the san francisco board of education during the regular meeting this issue has been discussed and

come up with our board of education provides oversight and jurisdiction over sfusd. and it has cull monated in adoption by the board of the resunrised policy and response to student demand and voice i want to highlight 3 areas where sfusd has been and will continue to center student voice and agency on addressing sexual harassment and sexual assault in schools the new federal regulations through boyden administration a departure from trump climate approximate policy on sexual harassment and violence. student engagement boy the title 9 group and take nothing concerns and investigations seriously through procedural practice. new federal title 9 revving lazes part of sfusd's commitment to increase awareness about the reporting process. [speaking fast]. announced the intention to

implement revisions billsod title 9 regulations earlier this month. the regulations are amounted to be in accomplice in time for the 23/24 year and the regulations allow for greater discretion for school districts like sfusd to out line procedures centering the needs of students. once office of civil rights released a final verse sfusd have the opportunity to intercept them in a way that centered sfusd students and responsive to the context of sud. [reading very fast] i want to thank student delegate hansen in the student advisory group last year. williams and her office have been per inning with city council leaders. to head up this student advisory group the second year this fall. and the student advisory group is a cohort of students grades

10-12 with office of equity of the development of more effective set of policies and practice across sfusd and this on going partnership inn gages with lynch top and collaborate rit on efforts to address student occurrence. you know there is a wide variety of objectives and out come through the student group. that we are happy to go in detail. lastly i want to talk aboutment aring investigation procedures. that was an wrir that has been identified as interest. procedural the school district encourages all stounts to report, of sexual harassment to a trusted adult at school. sfusd required to respond to reported harassment and any allegation designated staff will review the allegations and determine whether well is reliable information to pursue an investigation. sfusd designated title 9 officers. who are specific low responsible

for addressing incidents ever as a result and sexual harassment. before i turn it mrs. williams. student and social justice are among the core values that centers our work every day. and the safety of our students issor top priority. i will turn it over to miss williams so put our value in action. >> thank you. good afternoon. thank you for having us here. i'm excited shirr a bit about our small i think mighty office in san franciscouneified. i want to say thank you to the students. it has been it was them and i begin them the props every time they kick strpted the group that allowed mow to advocate for staffing when we were in a budget crisis because of their voice really did help. i appreciate them and proernlted having a chance to know about 10

or 11 in the spring and now we have 7 or 11 this fall to continue the work. office of equity is i department within sfusd legal division. i have been with the district for 7 years. over see title 9 compliance. bully harass am complaints. we have new investigator and a title 9 coordinator and point side case coordinator there are 2-3 that over see the work that come through. i want it stay that title 9 does limit. it is in the in a great accomplice now not student friend low we said this from the gipping. when we pass said the new policy to comply if 2020 we passedure bull and he had rasment policy the behavior is not acceptable. harassment i work with our

school add administrators. i train all of them your low and our wellness upon staff our nurse and social workers and athletic directors. um wellness coordinators yearly we are pushing out more information to teachers. we do title 9 and student body we are kind of focused about the students delegates raised. when an issue is reported people notify our office. we consult with them to determine which policy is falls under if it is reaches that title 9 level a complaint is filed. and if it does not respect tiling 9 threshold the school

site investigates and support them through that investigation. it is very prittive and confusing and complicated an investigation is done and investigation conclusion is reached with support for students. what i don't think we did a great job in 2020 given everything going on not a great job and hold accountability was explaining the different process. it has been novelty transparent but explaining that it is not title 9 does not money it should be taken seriously. that is something i was hearing and -- why we brought forward the policy this earlier in october. and to clarify the information i don't think was clear in the policy. beef up the 2 policies. waiting for the d. education to release new provisions when i'm exciteded about with our

students delegate group they will work with our office to create our next policy there is an avenue for studentses and we encouraged all to apply and anticipate that's our version of the legislative process. board policies are policies that guide our work and revving ligzs how we do them. the 2 documents and in addition to bull and he harassment policy is when we will be working on overnights next few months. i encourage all students interested in that work and framing our policies and framing how we move forward in this work as we comply with the luto reach out to our office. there is on sud suds website is information about the student group. we will be hopeful low through our student group purke out information to the different schools and getting feedback this way. that in the spring we have an idea where policies will be once

the regulations are release exclude make sure our policy complies with that and as we push this out tell be another lift to get everyone trained to get everyone the support so they understand the now way of doing things. we also have a variety of curriculum the district uses. i am not responsible for the curriculum that is a different department. when issues come up we do lone on our school partners to make sure are we investigating coming to a conclusion and educating students we are school districts and students have a right to be at our schools. really purke out the education. what i am hope to get to with this extra investigator and sfaf member is starting to shift the folk you to react to get working to prevention the delegates mentioned that it is a focus now that we have afternoon

additional person in the next year and in religion to the new title 9 regulations i hope as a district with different departments we continue to talk about robust and starting young are, too. i'm that he want to answer questions. >> thank you very much, if is okay i have a couple of questions that -- thank you for your presentation and for your work. and i of course this you know especially if the elections go the way we want them in november there will be more resources for student wellness and curriculum development and things we need for prevention. you know title 9 is you know a requirement of receiving federal funding the bear minimum we do. and it seems the students are asking for accountability that goes beyond title 9 that is something i did not hear in your

presentation. so, you know aside from comply with title 9 you an employer sfusd is an employ and has a system where than i are in charge of minors and so -- what are the policies and procedures beyond title 9 investigation when you also mandated reporters. if well is a teacher who notices an athletic director checking a student out of class repeated low for no reason that is not a tiling 9 issue. there is an over lap but a mandated reporter duty to rescue noise that something is amiss and account act mechanism for this staff person. i'm not sure is your jurisdiction it is under hr and they are not here. how does that go? it does. i wir a hat of over seeing

employee relations. a few things i appreciate this question. one thing every staff member is strained year low on reports. we through our boundaries i can't speak to your the case you are talking about the situation. that's in litigation we had not speak about it it happened often enough. >> things like this we are training our staff member when is they see something concerning they report to the add administrator and add administrator holder of that information receives information if a variety of different things. we have done many trainingos recognizing abuse in schools for our administrators to hold and push out to staff members. this is something we are bringing back all high school staff will be trained on ecrecognizing abuse in school when is that is brought to our

team we dot investigation ourselves or support school throughout investigation depending the level misconduct reported. should report to child protective service or sfpd if we some child abuse that's our duty. everyone of us. and then we also have a responsibility to investigate to determine if our own policies are being violated or child abuse is happening that is a focus. san francisco had the of first policies on the books of anyone we hand transistor today to recognize i think about 5 years it has been in accomplice. and pushing out this information gwen to our school sites to over 130 school buildings with staff and different agents is something we focus adult to student side. >> what happens when it is students and students involved

in a sexual assault. >> if it riseed a sexual assault, which tiling 9 we have to do a long title 9 investigation at the district level. it ends uptaking our office 60 to 90 days on top of the investigation, we have to do a 10 day report evidence review period, write a report and another 10 days for question and answer and a different person from the investigator has to issue a written determination. it would made intentionally long i think people who know who wrote it put it in place for. and so when a variety of different complaints come in we figure out at the district level with 2-3 people had does this investigation. testimony does take awhile it is difficult for students and something i'm looking forward to not be a requirement moving forward. >> during that time the investigation is taking place it is possible for the victim and

the person who is accused of aggression to be sitting side by side in the class. should impelement supportive measures particular be a class change if this is promote. we can't do before the conclusion of the investigation is do anything punitive. anything that can be done during that time period should ch is tough for students and schools to manage is to figure out how we provide supports for both opportunities not punitive and making a predetermination before we get to the end. before the revvings went in accomplice we moved through investigations within days and weeks. the revvings they put in ing tensionally slow third degree down. some concerns we heard from students predate the revvings that is not the only concern i'm hearing i'm not going to blame this all on that. pushing out curriculum, training of adulls and transparency i heard cal talk about poster we

have posters are they great, no they are of created by again an office of 2 or 3 am. we are trying to be wellness center with resource hub so people go in. one thing we ask is how do studentsment to receive this information. is it on social modia, in person, posters? and so if it is all of them we are work to try to push out that information. and that is when i'm thankful to the group about is being per ins in that. jury room thank you. miss williams. thank you. >> so next up we will hear from mariah sue. director of the d. children, youth and families. and i think we have jazmin dawson dpept director of community per inship you minot know this but miss sue is a

child psychologist and has for a long time been a champion of children and an expert on everything to do with youth and trauma. thank you. director sue for being here with us today. >> thank you supervisor melgar, mar and stefani for call thanksgiving important hearing and before i story i want to thank the stounts who are here today. it is clearly a demonstration not only the commitment and advocacy you have but clear this is an important issue. not only for yourself and peers, school and your communities thank you for coming out and representing and speaking your truths is hard. it is heard for adults to do this let alone young people. my purpose today is it talk about the way the city wants to

and ask supporting school district. and i have with me also -- alison from the d. public health. so i doment to just emphasize that this is a very complicated issue. however. it is it is know issue that needs to be addressed. i appreciate the words that our students delegates shared as well as the reformed strengthning of the system our am school district partner system enengaging is which is important. our student delegates made irrelevant amazing and very intentional and thoughtful recommendations. that dcyf and department of public healing are willing to support the district in building out. so just really quickly to mention i fully support enhajjesed trainings.

i agree we should start trainings about consent and about what is appropriate and not appropriate touching and upon engagement in start nothing elementary school the recommendation of our young people temperature is important for whoefrn participate in any program regardless of sports or other programs to understand the importance of these big issues. and dcyf is working with the district as we develop a curriculum for trainings. is look for the everforward working with the wellness center services that is as important. having a safe place for young people to go and talk to anyone what they are experiencing as

they try to figure out happened. we will figure out how we can increase the services and that capacity and at all the high schools. i will take it a step further i will also commit to figuring out how to expand service at our middle schools as well. this is -- an issue that impacts all of our grade levels. so wellness centerses are found in all of the public high schools. and in our middle schools we have beacon centers. so we are look nothing expanding the mental health compoint at the beacon centers so young people experiencing the issues will have a safe accomplice to go and talk to an adult. i have a brief presentation. that highlights all of the other service that young people can go to to receive support in the community. these are programs that are both

found in schools at important school sites and out in the community. so for some young -- for some young people who don'ts feel comfortable at their school for whatever reason, there are other accomplices within the community within our san francisco that young people can go to to seek support and help and both counciling and add voice. and you can see here on the list a number of nonprofits this dcyf fund of ranging from mentorship and case management to active prospects that are gender based. supports young women and programs to support young men as well and support nonbinary young people we fop make sure it is not just a girl or boy tissue is

issue around safety and people who make others not feel safe. we have a number of different programs within our city that -- provides this time service and support for young people. >> >> in terms of. partnerships the first one with the school district wellness centers. i shared i am committed to expanding figuring out to expand the wellness center capacity but using the wellness center to support the trainings and roll out of information to young people throughout their school. we also have a partnership called expect respect sf at san francisco city college. run through there and works with a lot of our nonprofits to provide supports to young

people. >> and then with that, i'm ending my part of the presentation and i will hand it over to our d ph clothe hol share the resources they offer. thank you, director sue >> can i ask you before you leave, with more resources which you may get, would it be possible to expand the license and resources for students? >> absolutely. i will say that we don't need to it wait for the resources to come this is such an important issue that i shared earlier i'm committed to w with you and supervisorster neil to figure out how we can make this help as soon as possible. >> thank you. >> hello supervisor i'm going to talk today about the treatment options d ph offers to those who

have been victims of sexual harassment, abuse and traumaticasm i will start with the program our go to flag ishmael program. we call it case ait is san francisco gender under the trauma recovery service this is is an if you mean spectrum program delivers mental health service, therapy, medication if indicated. case management. that's one arm the other arm is a forensic arm. if the youth and the family decide they want to involve law enforcement, case provides forensic service through mdand that team consists social worker, nurse and someone from the da's office and a victim's advocate and they gather the evidence and also support the

family and the youth through the court process. the third thing they do is if a youth and family is already in services with someone, when you have a trauma it is difficult to have to keep telling your story. if you already have a therapist or someone you work with that you have a good relationship with, you don't want to change that at this point. offer help to that therapist to help them work with the client on the issues that may come up ordinarily the abuse. those are the 3 things than i offer t. is comprehensive around since the late 70s. in addition, we have our comprehensive crisis service where if a youth is responsiblesing an acute mental health crisis they foal they want to hurt themselves or someone else, reach out to our child crisis. they are also the designated agency within our city to initial a hospitalization. if you are also in crisis or

feeling overwhelmed it is in the acute you don't feel you need a hospital, reach oust to our mobile response team. they are available. they have a very good rep in all of the schools that's where they have been working and they can help to stabilize and stay with us and w with you and your fell to get you throughout crisis. in closing i want to say that trauma does in the always materialize in the way you think it is going to. some things are very hard to talk b. thereupon is probably nothing harder to talk about than sexual trauma. if you see someone you know i say this to everyone in the room if you see smun and not notice their behavior changed in i way, either they are isolating, grades are dropping, partying more. reach out to them and ask them what is going on. check in on them. because some things are

irrelevant hard to talk about. and if we electric out for each other this makes a better community. i close with that. i thank you, thank our colleagues from dcyf and the students who came you are very brave and making a difference. thank you. >> thank you very much. >> if you have questions. >> i don't. colleagues. >> thank you. >> thank you. so -- our last presenter is i'm sorry. du -- jazmin did you have manage? no. our last presenter is i'm sorry. divorce enthusiasm a policy director for office of the sexual harassment and sexual assault response and prevention. to present on the office's complaint process, data insights, best practices and work on gender based violence

prevention programs. thank you so much for being here >> thank you. we have slides we can get those up, please. thank you supervisor melgar and mar and stefani for having me. prior to my role at the office of sharp i was at san francisco [inaudible] 7 years as community education consult analysis. i was providing work shop on what is sexual assault and rape. violence intervention and supporting survirus at high schools throughout san francisco. i want to thank the youth here. thank you for elevating your store and hes voice we are proud of and you we are here to support you. at the office of sharp, we are the gender based violence prevention division of the san francisco human right's commission. we work to ensure that survivors are believed issue responded and treated with dignity by city gentlemans when voicing their

responsibles of sexual vinyls. advocate in city government for survivors and work to transform and create new system approaching and address end sexual vinyls. office of sharp envisions a san francisco with no as a result or sexual assault. and should envision san francisco with options so a survivor can choose to address the harm and heeling process. each. working to end the violence as well as condition in which able to occur. the sharp office has 3 focus. . we do advocacy, policy and prevention. through advocacy we receive complaints from survirusil talk in the next slide. we have 3 complaint form this is survirus can fill out. am complaint forms inform the policy work that we focus and

build survivor lead community coalitions. our office was -- created by survirus of sexual violence with the support of supervisor ronen. focus on prevention. we collaborate with partners and organizations to teach in public education. and education -- to shift the culture of sexual violence to credit a san francisco without sexual violence. . through our office we have 3 complaint forms on the website this survivors can fill out. this includes students who may have complaints of city government agency such as sfusd. we have 3 complaint force 2 are similar. meaning that the unanimous and advocacy requests forms other am same the difference that one is unanimous and one selects

constack information. all the complacements help us inform the policy work we do and helps us collect data and our last is called, we honor your decision to not report tell us merchandise these forms and these forms can be filled out boy survivors themselves, teachers, counselors, youth organizations who are offering services to students who are going through this process. >> as part of our prevention efforts we have agenda prevention collective. for us we continue is in the about sexual harassment and visual, verbal or visual ways or sexual assaulto rape.

some is gender based violence. some students face a specific violence because of their lived experience. more identities that a student holds that are marginalized the more likely they are to experience violence early in their life and more often and the more they are marginalized. if you have recent rivals the violence that transgender nonbinary students were facing. and so it is important it address but violence is compelled billsos student identities the gender based violence collective, our mission is we are a group of organizations and advocates from across san francisco focussed on

clan rit to end the cycle of sixual violence and trauma in the city. we stands up to those affects offering solutions as change makers. we do this prioritizing heeling [inaudible]. showing best practices and using transformtive justice model. weave have received a formal complaint the asked for support and system changes are high school aged students facing sexual violence in schools and communities. >> one way we uplift the voice of youth is this past april sexual assault awareness we hosted our future our voices. a conversation with san francisco youth on the impact it is of gender based violence. through this panel, we

collaborated with chinese progressive association, mission high school public health were path way and collaborative. and we invite to you watch this an hour town hall. on my facebook can you watch it. i put the quotes the students shared during the panel, students should not have to pick between an education or feeling safe at school. the nonbinary transgender youth at a greater risk from verbal harassment to physical and psychological harm. studentsment to be at the front of making policies that address these issues. >> we are also very luck tow have a partnership with mission high school public health path way program. we are able to hold high school interrence throughout the semester and the projects this

they have created here we have an example of a [inaudible] that students created where they created with peers lighting defy nigsz. signs unhealthy relationships. pod casts about peers can use as a resource. as well as education videos on consent. identify sexual harassment and more. >> woo collaborated with project survive. we have been able to host 8 students entering the wellness studied by the course names and sexual violence at city college. most useful resources the city intern created was the creation of trance formative justice resource bank. we know that expect upon is the many solutions that exist. and it is position to offer

abuse prevention and peer for young family of color we want to highlight the course exist buzz they are a resource and build enrollment to foster leadership among students. i emalso. to say how give -- special limitations to the youth and the students that are here. we are office at insure is hope to host a town hall this fall as well as a youth summit. a heeling youth summit in the spring and invite to you be part of our planning committee to cater to your needs and address the issues you bring and up also create a heeling for you as well. that is a part of the process. thank you for having me. >> fantastic.

thank you. colleagues, i misspoke we have one more pair of presenters this is the folks that [inaudible] just talked about project survive. city college of san francisco. . women and gender studies that is adel carpenter and shellis [inaudible]. joy want it apologize for not acknowledging kelly [inaudible]. thank you, kelly. >> good afternoon supervisors, i'm adel carpenter on women and gender studies the city college i coordinate project survive and respect san francisco which are peer lead prevention and programs i'm here with my colleague.

hello i'm the dual enroll am prosecute if he was or at mission high school. teaching of the project survive courses there. we have slides. thank you very much. so a del gave us an introduction. next one, please. okay. project surviv is a 28 year old peer lead healthy relation and sexual approximate domestic violence prevention program in women studies at city college. it has been run by instructors like a del special coordinated. what do we offer? we have wonderful upon expect respect we offered presentations to 2006 that idea was brought to our founder by a frequent survive peer educator and came to fruition in 2006.

have 2 in house class rooms an institutional part of be real and be ready curriculum this sfusd uses. coordinate a collaborative of community based organizations provides abuse prevention and sfusd and we provide resources with students, teachers wellness centers staff and like basically what i do the dual enrollment at mission high school leadership develop and want job opportunity are available for sfusd students and alumni. next slide. so our city college of san francisco students upon gain paid experience at peer edindicators the model of expect respect is peers youth listen to people who look like them with the same energy and it is amazing. . this model brings students in

the class with focus trinning and hiring of sfusd students. and graduates dpo often returning at peer educators. expect respect san francisco is a part of sfusd health classes. so now all of sfusd high schools now offer healing education classes in ninth great. expect respect is the preferred provider healthy relationship lessons curriculum in the be really and be ready curriculum. next slide. a bit more about the curriculum that our city college students lead in the high schools. twofl day lesson. again in the ninth grade health class first day healthy relationship questions of lawings issue healthy bound easier and understanding power

and oshg preparation how this shows up in relationships and we explore gender roles with the students. on the second day oir our educators on the cycle violence, recognizing signs of abuse and practicing verbalizing consent and understanding how to negotiate consent on a date thinking about risk reduction strategies. next slide. so, we then and there time education as part of a comprehensive sexuality education like sfusd has with be real be ready does help prevent violence when there is a skills based focus with students until college. >> so the student who is go through the curriculum report you know learning new information, feeling empowder.

these are quotes from students who completed the curriculum. one city council said i learned rip does in the occur because of unkrellable sex driveway it made me feel knowledgeable the way different ways rape is not okay. happy to share more about when we hear from students but that is an example the feedback our peer educators receive. so, like shelly said we have been in the school since 2006. our 2 day curriculum has been institutionalized since 2010. before the pan emic ed indicators were in 16 high school and over 230 present anticipations in sfusd every year temperature is important to say this does in the meet the full need for prevention education in the high schools. we are talking to freshman who

are less likely to begin intmate partner relationships and we than a lot of calls for prevention sxejz further support are coming from our lefrn and 12th graders we want to address that and anchored with niejth grade and ares inspect 230 of the classrooms a year. during the pandemic we pulled back to offering a one day curriculum in 9 high schools and as of spring our peer educators return in the person and building back our lead are ishmael pipeline and theme say our students will be in 80 classrooms this semester. >> we also work with the community collaborative and other community based organizations doing work against gender based violence. also to coordinate out reach to schools and address the needs the schools very much we have a group ever partners that offer a third day on additional topics

of interest to classes like sexual harassment, cyber bully and women against rapeful young asian women against violence. we work can the lgbt speaker bureau. and lacosta madres. we are beginning cord in this case with huckleberry youth and black women revol geans and we have members of collaborative that consult on out reach to high schools and the curriculum includes sharp, welch inc. and the reilly center. etch force force so i will talk about the leadership development we are offering sfusd. we are lucky and able to offer courses that [inaudible] mission

high school and balboa. since 2020, we have done our project survive training course at mission high school. as a part of the course volunteer with sexual assault the presentationless and education advocacy at school and actually get appropriated for jobs and expect respect and public health programs. that they choose. . >> i'm the proud professor of 2 [inaudible] of students leaders at mission high school i adore. 20 students in each cohort. they have actually learned and practiced fasilltation skill in other class rooms at mission high. done public service announcements on healthy relationships this they recorded and debunk myths and stereotypes on sexual violence.

present anticipations they created and practice in the other health classes and involvement in voicing needs and occurrence of these things at school. >> thank you. so -- we are prevention education provider but we also imagine ourselves and tends to be part of a leadership development framework for training educators to work in this field it is difficult to hire and retain nonprofit workers that can lead this work combating gender based violence and want city college to be an engine for training and people go in the work and be supportd and have a network of people they can rely on once theyir in that work. we have a 16 unit sexual health edcarrollton certificate that educators are completing.

the upon training classes to be a peer educator. and this aims to train students in safe and healthy sexuality and the promotion of healthy relationships. and during that training they receive both paid experience of project survive and volunteer experience with agencies doing do met and i can sexual violence prevention. connect with mentors for careers special human service. the certificates say this paid experience in the high school class is what prepares our graduates to work in the field of do met and i can sexual violence prevention and intervention. we are froud have our educator graduates working in sfusd and in the wellness centerses with the district and directly in the abuse prevention community based

providers. we want to bea i partner and engine for developing that leadership that is happen happening where alumni carry this in the schools and neighborhoods and communities. we can skip ahead. i will say it is not the scope of today's hearing we also intend for classes to be available to the staff and teachers at sfusd as well as any students that want to enroll am. the pact ways we offer our 2 project survive training course after school during fall and spring so partners and students can join. we also offer a free self defense class available to high school students and evening masculinity study's class it is an important part of this universe of upon gender based violence prevention. so you know we have really been

looking how we responded to the calls come from student who is have inaugurated this conversation and one challenges is we are focussed on the community side and prevention side and the demands in the student letters focusedod need for intervention and support in the district. woeful have been think burglar when can we do as we expect respect collaborative in terms of the requests from schools in the aftermath of the student walk outs, there have been requests for support with school wide assembly and training with staff training on title 9. on by stander intervention and understanding sexual harassment. for support for fasilltation of girl's groups or discussions about gender based violence and requests for in person work when not all the collaborative partners were ready to go back

though i'm glad to say search back to offering in person or hybrid options. challenges this we are facing as we come out of the pan dem and i can try to the not only rep establish but grow this work and meet the demand is city college has lower enrollment. due to class cuts in 2019 that impacted our leadership pipeline. and so we want to. have more students that are employed at the college treed go in high school and do this work and work to buildum this leadership pipeline. that was reduction to student work upper wages during the pandemic we are q.ed this our chancellor has committed to restoring. on the community partner side we seen that people have difficulty hiring and retaining staff because of the cost of living that was worse during the pandemic and this it is another reason we are really look to

build enrollment and project survive in college. certificate program is to continue to have a group of folks that can fill the role and wills build up the work on the community side as frontline staff. and then in terms of per inship with the school district we worked closely with the teachers on special assignment in school health to create the linkages to classroom and book in classrooms because of teach are shortages we seen the teachers on special assignment pulled in the classroom which especially with teach are turn over can impact how quickly rereestablish the relationships with classroom teachers. bottom line the demand for this work is up we hear it from students and schools. but in terms ofy meeting that demands the deep are issue around how we resource the school district, support service and how we very well source and

stabilize city college and stabilize and raise rages for nonprofit workers to retain them in the field the issues you hear about impact this w we are doing the best we can to be in as many class rooms at possible and hopeful with shellis and students at mission high school now able to go in the left-hand laneth and 12th grade class to meet more requests we are hearing from the student leaders who lead walk outs last spring. thank you for your time and thank you to the student who is raise this issue. >> thank you for this thorough presentation. why do we have questions for any of you are presenters? supervisor stefani. thank you to the students the presenters. i have a 13 year old daughter

and 17 year old son and just sad you have to advocate for yourself there is this and gun violence i remember when students walked out and came to city hall to prosecute test gun violence i admire and you think this generation will save a lot of us from a lot of social ails. i do admire you and i just was not clear on what the status of the student demands are. i would like to get clear on that. there were presentations but i don't know if it concludeod where we are with the demands. >> cal, do you to which sarns this question? upon now the only student demand that has been philadelphiaed from tulths 9 is to official lohmanidate init wroog investigations must take place under tiling 9 and sfusd bully

policy. >> what has not been met? that one yet where was implementod october 11 with the board bull and he harassment policy changes. there is a bunch that have not i was asking if you would restate. a couple ones not met are the manualed torrey orientation and company wifr for student athletes auditing health curriculum consent elementary schools. ensuring walk on coaches and athletic directors are put through same training for sensitivity and professional development courses and ensuring more easy access it tiling 9 resources through posters in schools and digital means like the synergy app that students check their grades on. why and follow up, do you know are you still advocating. are they telling you, no on them? or is it more open to

discussion? where are they with all of that? sdwroo hymn guess become to the issue i touchod last which is the governors change they did pass sort of a slate of reforms with the consultings group helping us with the practices which include not allowing 4 residence loulgzs to be passed. i mentioned resolutions sponsored by board members have been the student advisory council and delegates only way to propose policy changes now we are at the mercy of the board to implement when we have been asking for and as far as that is going there is some discussion but fairly paused not a lot of move and want it is important to mention that the title 9 reforms the previously mentioned about ensuring all incidents are investigated under title 9 and buildings harassment was not

approved not guilty week before the date for this hear exterioring we had not seen much movement up to this point. >> thank you were >> thanks again. to the presenters. and -- appreciate hearing the update and to all the young people here. who are purke and demanding real action to address these stloojding and growing occurrence. around sexual harassment and violence. go to public comment i know there are a lot and possible low on line thatment to speak as well. >> thank you, member of the public who would like to make comment for item two lineup along the wall to the right. remote call in members press sar3 to be add to the queue. for those on holds wait until the system indicates you have been unmuted. prop the podium if you would

like to speak. >> there is a timer. you have 2 minutes and the light will influential on the podium. >> thank you. hello i'm am [inaudible] i'm a journal in mission high school. i lead the [inaudible] students against sexual harassment at my school [inaudible] i'm he were students at school don't feel safe not able to or feel comfortable with seeking help from schools. apparently with -- sorry. many sfusd schools don't have resource in accomplice to support survivors groups and systems and therapists that specialize in supporting survirus i'm not a survivor this worries mow and otherers runts

risening being harmed by going to school. sexual harassment affects every student and unacceptable how this is an issue for years and before prosecute tests at mission high the wellness center staff said to me exteriorings carefulful of when we said scientist information we gave out. for the safkt attackers. hoe worried how the attackers were treated do you to the prosecute test instead of survivors who had to go through the trauma. the support system in schools are flawed and the trusted adults more harmful than good to which help with issues i ask fudding prosecute voiding therapists at school who is can support survivors. be seconding programs in thes topic surrounding sexual assault with schools and creation of

transparent responsive system this separates survirfrom attacker moved thick out of shared classes and hold the attackers accountable boy money of proper pun i shallment if proven guilty. >> thank you. >> i'm dylan i'm a journal at mission high school. i'm the coleader of the students against sexual harassment and violence club with miami friend tyler. the issues we are talking about sexual harassment and sexual assault are close to me and seen many students affected by them in the place we are supposed to be protected. city councils don't feel safe coming forward with stories our administration does in the take them seriously we write store necessary bedroom stalls they are treated with more respect there then and there boy teach and ares faculty.

too many aboous buzers run free. i have a thouz dmansdz but story boy changing the title 9 legislation. ful this process sub easily stream lined. so this survivors can have representatives ding designate nited tell store and he protect survivors. will second low survivors deserve a place in jol they talk to tr all and hole we need proper violence counselor in schools and don'ts have them now. third, abusers need to be taken out of program s and classes that if victims are in such as. sports and clubs immediately. the survirus heeling process should be held in high regard

than abuser rehab. we can't allow sfusd to put the future of abusers first it is heard to heel when you see your abuser every where and sfusd has been bad at separating victims from predators. title 9 defends students suksualy harassment on school grounds. i'm a woman who experienced sexual harm first hand. each student deserves a voice. many i know were silenced they felt a lack of support and safety in the sfusd. is it is important we make

school a safe place. i never felt confident in sfusd to report hrm i experienced because friends of motorbike have reported and nothing was done i felt it would do more harm than good. i anyhow it would bring drama and shame i would be blamed. if we had more funds and support systems less experience will share the response of mow and otherless we want our schools safe and this would be bring us steps closer. some ways is by using fund to improve public health pregnant ways and better support for students. thank you.nant ways and better support for students. thank you.ways and better support for students. thank you. >> i'm a junior at balboa high school. i experienced and witnessed sexual violence in sfusd since

fifth grid and little to no action on the issues. i have been compared to porn stars on campus since i was 12. my sons were sexual harassment the differ thing the dean said is they should cover up. i'm in an investigation myself and i had no idea what was happening i middled hours of school and my graded because of this. this it is not okay. sfusd needs to take immediate against against abuse are remove them from classes when allegations are brought up and community every step of the title 9 process with the victim. survivors in sfusd deserve better they deserve respect and communication and not have to sit in classing with their rapists. consent used to be talked about throughout their education with sfusd. and sfusd needs to do better.

>> thank you. i'm sean gomez i'm a junior from balboa high school. on september 30 i was choked out by another student. add min was not there to support me not guilty following monday and he was suspended without me knows and i heard this from another friends they did not let mow know when he was returning until i see him walking around. . sorry. another case i filed against a separate student i was asked to change classes not him i should not be affectd and his should.

no case has been time exclude have not heard anything from sfusd or title 9 case sorry. take your time. i have been verbally assaults pinned against lookers sexual harassed this cannot happen to sfusd students moving forward i would like to see all staff trained on sexual harassment and school wide assemblies about preventing sexual vinyls. elementary school students should be taught by sexual harassment and violence. thank you. >> i'm [inaudible] valdez a 12 grader at mission high school i live in the south of market i'm a youth out reach worker a student educator and i'm taking

the student enrollment classes i'm here to support students and one of the voices for upon many students that were in the able to come in this hearing. when i go to school i expect it to be safe like any student in the country t. it is a space to learn with no worries and escape the dangers of the outside world. in reality there is no staif place for students if i walk through halls where there are people that have hungry wolfish eyes where they are spearing cat calling is normal when i break that expectation my friends tell mow i'm too extra. there are situations that are way worse in mission and especially other schools. this is why i asked shall ask for a request for the city to run changes and sfusd schools when it come to sexual assault

and sexual harassment prevention and response. this monies it give more machine tow public health programs it train student educators like me, improve the title 9 process and mental support for students by trained professionals with emphasis on the assault. and final low to the other points that other people have said in this hearing. thank you. thank you for this hearing i'm karen i'm a mother of 2 sfusd students. i'm a canned difor the board of education. professional low i'm a diversity inclusion educator and if silltate sexual harassment in work accomplices and survivor of sexual assault when i was a sophomore in high school by a popular athlete. and it it is facted me my entire

life and iment to thank all the survivors who are here and all the supporters for being a part of this hearing. what i heard throughout the campaign is students, educators, staff and add administrators don't feel safe at sfusd schools. the culture this sfusd must change and that will require every adult connected to sfusd to unite to have clear behavior expectation and to uphold them. to offer school wide training to teach people to. believe survivors to teach people to be up standers. hold people who cause hatorment account and conduct investigations quick low and fairly and begin in k to talk about consent and pleasure. sex is an important permit of life we want to teach about it

in a sex positive way. >> hi. everyone i'm emleap nguyen i'm a high school student and the chair of on the san francisco youth commission. today i want to talk about the issues ever bureaucracy in the da's office and police department. between 2003 and 2013, 753 rape kits despite legislation mandate all rape kits must be tested. additional low, in 2016 the department of justice audits sfpd and offered recommendations 91 addressed the conscience in the special victim's unit. we urge the da office and sfpd to test all rape kit and begin

an investigation in fret hours of receiving them. we urge sfpd to virize youth voices on sexual assault and sexual harassment. lastly we urge the sfpd to properly assist survivor in filing a police department in getting medical care and holding perpetrators acountsability and maintaining survivor's legal rights in a timely manner. thank you for your time and calling this hearing. >> thank you. . i'm [inaudible] will plummer i serve commissioner on the san francisco youth commission representing young people across our city. i want to thank you for taking time for this important issue. and to urge this to be the beginning of a thorough press ensuring student safety and well innocence san francisco schools. in 2005 the youth commission

published i report on sexual assault and sexual harassment in our schools show the the factor in preventing students receiving support disconnection with services and students in schools. other recommendations from the report offer a public information come pain to be created for services teachers trained on sexual assault and sexual harassment and levels of funding for counseling service in schools to be maintaind and increased. orth report. created in 2017. . by the safe school task force created this report. it ecode the same recommendations of initial report showing how little had been done. here we are again years later asking for more. we are asking for the same things. we urge the sfusd and all school

in san francisco to impelement mandatory trin anding information campaigns on definitions of sexual assault and sexual harassment reporting prefer and how to support students and how to prevents the crimes from taking accomplice newscast first accomplice. the board of supervisors we ask you restart the safer schools task force. this time with youth voices represented on it. young people deserve safe and welcoming learning environments. it is something we should be able to pride ourselves on. we can't yet. we need leaders like to you protect and support students. thank you. >> hello. a.m. district 5 youth commissioner and a journal at

local high school. we take half a year any year you can go through off the high school and take your last semester. and the classes don't focus on healthy relationships can send and dealing with trauma and getting meantsal health support or retruckive health services and our curriculum is up to parwhen i took healing last year my teacher used an out dated curriculum telling us the hearsay of alcohol approximate american but spent a few dayos healthy reps, concents and all of those important topics. and there is, legality of resources available through the community organizations that we heard from today. snients are just not aware of the resources and the school fails to promote them

temperature is also hard to acswhesz there is in the resources at the school site where students reach them during the day. with wellness, you students will hesitate to go to service as they foal they will fall behind in class work when they take time out of their day to take care of themselves. we want to urge that dcyf and sfusd prosecute void more fund to promote access to resources and improving the health education curriculum. thank you. we see abuse ask to be open and receptive to learning how can than i learn not safe or being

seen or heard i work as an educator and have been in awe with the positive impact on the youth we serve. reading the religions i feel educate and learned do relationships better and pooh hope it shifts how we learn to do life respectful low. i share third degree with adults living across california. and repeated low they ask where was this when i was younger. overnight past 3 years the world watches the political system bleeds out beauty it highlights yours that need attentionful i have livid here for a year and in the middle being a strange and embracing the city but wander will you be a part of the heel and listen and person from the past to credit a better future. i ask to help us butt reality is we can't retory what we have not achieved.

will you help us get close to modeling when safeties, trust and healthy reps looks like for generations and those to come by supporting it is programs it is in longer of replacing mandates we are move to complete transparency you will see with us and the lead and catalyst of change for the city of san francisco but the state of california. thank you. we'll now go to the remote line. forward of the first caller. >> hello can you hear me? yes. >> hi. i'm dale smith from san

francisco i grew up here. i went to charter school in san francisco and worked with project survive. i want to highlight the fact that this was a problem i was in high school was have the exclusive to go to high school when is i was attending them and that's i want to underline the fact this hen a problem this is not new. this it is something this needs to be taught young to all student in san francisco public, chart and private. regardless of sfusd has oversight over their facilities. it is seen as a secondary education rather than something required. the things during the presentations upset me and it got worse due to peoples way of socializing being with others through social mead naacpia it is mandz torrey learn nothing all schools at all levels.

sfusd has to provide better trarnz lagz services. many are forced sit in classes with no translations or a teacher that speaks their language these are vulnerable. it is heard to believe that many folks are learning anything in the school fist learning basic english of the same time and needs to be a trans layer in all class and support to the teachers to learn the language and the students they serve. thank you. >> thank you. forward the next caller. forward the next caller in >> oh. hello can you hear me >> we can. i was moued. hello this is a lita fisher.

parent newscast district of 2 mission high school graduates a concern mission high school students, go bears and eighth grader. first of all thank you very much to the sproirss for holds thanksgiving hearing. sxf more important low thank you to all of you there sharing your store and hes being brave and doing the work. will telling us all what we should be listen to and should have been hearing for years. thank you for highlighting this and you should in the have to which this work should have been done decades ago. thank you all for being here and talking about safer schools sexual assault task force needs to be restarted. thank you for sharing your raw stories and experiences. . our district has a history of focussing on compliance rather than commitment. and hopefully

we move past that and listen to our students. and their needs and putting their safety first and foremost. and we hope this the city will stand and up help nus that endeavour. thank you all. and i hope this is the first of many partnerships and collaborate rigz and hearing on this subject. thank you. >> thank you for your comments we are checking the lines. there are zero callers. >> thank you. public comment is closed. and i just want today thank all of the young people whom spoke out passionate low during public comment today. and sharing your stories and your demand and ideas on when really needs to help to address these issues you have been demanding more real action on.

you know for a language time. thank you, everyone. i wanted to say that -- i really appreciated all of the comment this is happened today. i took detailed notes and appreciate all the specific proposals for change. a lot of it does seem focusod the district and sfusd and the school cites need to take the issues more serious and to take more bolder and impactful actions. and but some of them i think connected to the city and the board of supervisors calls for more funding for support for survivors in schools. they're poe and other services and you know and -- resources to support really great programs the public health pregnant way and the city college -- project

survive. yea. so -- you know hopeful low boll ballot measures will help and also we as a board and city need to look at these issues and how we prioritize the budget process this year looking ahead. so and i appreciate the comment from bark are plumber the need to look at reverifying of the safer schools. sexual assault task force so there is an on going oversight and conversations and actual solutions across the city and the school district and city college and the students centered this is simultaneous i supportful supervisor melgar feb.ing thank you for calling for this hearing >> thank you so much for the time and accommodating the

hearing later so the young people could come and participateful i wanted say, thank you so much for your advocacy and showing up and for you know speak truth of power and your fierceness and courage in coming forward and speak burglar these issues. i want to thank sfusd staff, thank you for being here and listening to the students. andvilleidating boy your presence that when they are saying. we structured the hear nothing this way to center the voice of students and also to provide an over view of behalf is available through the city and community to make sure we all know that the school districts are in the alone in doing all this. per of the reason bypass supervisor robe sxen eye are around the community school model the things that are

happening in terms of the are projects survive and mission high school can be replicate in the all high schools. it can be adopted middle school. the community resources are there if we provide funding. and upon support to expand a robust network for prevention and crim patrol development on consent and motor vehicle listenity. femininity and all of the things that folks struggle with there are resources. great models that be rebelicated and brought to the school. you are not in it alone. i want it highlight there is a role for young people in all of this. there are were great peer resourgs models program this is are happening in our city nacenter the voice of young people and the agents of change and educating their pierce can

prosecute voiding that energy toward cullure change that needs to happen in our schools. and i am i have also like supervisor mar, have a long list of to do's out of this hearing there will being support for the safer school sexual assault task sdpoers including youth voice system something we now know that earlier was not taken as seriously. but also i will be documenting the things that happen and presented during this hear and for it a formal correspondence it is an important first step with the city, board of supervisor and it is school board in making sure that things are resourced and that the needs of students are met and centersd

and your voices are heard. thank you so much for coming and ficould ask chair mar we continue this to the call of the chair. this wave we can keep track of the progress made and condition to work with students so that you know -- next we're or wherever we can evidence an update as to progress on this area we come back together and taught successes. thank you. >> thank you supervisor melgar for calling and organize thanksgiving is so important. madam clerk call role >> item to the call the chair vice schafer stefani >> aye >> member melgar. >> aye >> chair mar. >> aye. >> there are 3 aye's. >> great >> this will be continued. madam clerk is there further business. >> no additional business. >> we are adjourned.

thank you.

♪♪ >> san francisco! ♪♪ >> this is an exhibition across departments highlighting different artworks from our collection. gender is an important part of the dialogue. in many ways, this exhibition is contemporary. all of this artwork is from the 9th century and spans all the way to the 21st century. the exhibition is organized into seven different groupings or themes such as activities,

symbolism, transformation and others. it's not by culture or time period, but different affinities between the artwork. activities, for example, looks at the role of gender and how certain activities are placed as feminine or masculine. we have a print by uharo that looks at different activities that derisionly performed by men. it's looking at the theme of music. we have three women playing traditional japanese instruments that would otherwise be played by men at that time. we have pairings so that is looking within the context of gender in relationships. also with how people are questioning the whole idea of pairing in the first place.

we have three from three different cultures, tibet, china and japan. this is sell vanity stot relevar has been fluid in different time periods in cultures. sometimes being female in china but often male and evoking features associated with gender binaries and sometimes in between. it's a lovely way of tying all the themes together in this collection. gender and sexuality, speaking from my culture specifically, is something at that hasn't been recently widely discussed. this exhibition shows that it's gender and sexuality are actually have been considered and complicated by dialogue through the work of artists and

thinking specifically, a sculpture we have of the hindu deities because it's half pee male and half male. it turns into a different theme in a way and is a beautiful representation of how gender hasn't been seen as one thing or a binary. we see that it isn't a modest concept. in a way, i feel we have a lot of historical references and touch points throughout all the ages and in asian cultures. i believe san francisco has close to 40% asian. it's a huge representation here in the bay area. it's important that we awk abouk about this and open up the discussion around gender. what we've learned from organizing this exhibition at the museum is that gender has been something that has come up

in all of these cultures through all the time periods as something that is important and relevant. especially here in the san francisco bay area we feel that it's relevant to the conversations that people are having today. we hope that people can carry that outside of the museum into their daily lives.

>> [applause].ves. [music] [music]

>> about 20 years ago the port was look to develop a network of open space and parks and to bring the art network and access to the bay to the entire 7 and a half miles of waterfront property. this location, 7 acres, identified a very important place to make a park for the community. the park was used very much for ship building. it was a very important location in the city's history. iot best part of the water front was heavy industrial and did in the have opportunity for the public to get in and enjoy will bay and connected to the bay. >> they incorporated the historical value of the area people can learn what was here before, what is here now and then really be able to understand the community that they live in. this was a vibrant ship building

area here for years and years. and you know here we got a slip away and for us to have an opportunity to teach our children the old way specials incorporate them in the new ways, it is endless. >> this will be an upon upon wonder uponful addition to the southeast sector of san francisco it is green and clean and beautiful and access to the bay from a park is just going to be incredible. jot things planned is going to make this a destination for the folkless in the upon community. ability to come out and have a picnic on the grass. and to come out and use the picnic area with the tables and bbq pit and movie night and food trucks has an open space is exciting. we don't are much of it in dog

patch. i think this will be a family and community based type park. >> the port is good about talking with the local people about things they might like. >> the whole place is a play ground they will not see anything like this before. >> i feel blessed have been part of the commission and the process of bringing this park to the community. this has been a long community lead process. >> open space is something we have been doing in san francisco for a long time. connectivity we have to the waterfront and san francisco is important. i can't wait to experience it as a residents and district supervisor. [music]

lwv board of education. >> the league women voters we're a nonprofit organization and if you would like to support our work, please become a member or donate on our website. today i'm pleased to introduce maxine anderson. born and raised, and the california criminal justice reform.