child crisis services. >> [inaudible] i am the director of comprehensive crisis services. >> i am the medical director of comprehensive child crisis services and foster care mental health. >> comprehensive price of services provide youth, adults, and care givers with crisis response services all over san francisco. we are comprised of three components. our first component is our child crisis unit, which is a 24-hour seven-days a week mobile crisis service which serves clients every year. our second team is our adult mobile crisis unit, which is a six-day-a-week unit with 60% of

our clients having prior, exposure. our third team is our crisis response service, which is also a 24-hour seven-day week mobile response to scenes of homicides, suicides, stabbings, shootings, and domestic violence. it serves approximately 280 clients a year with 53 of those being children who are exposed to trauma. our team is built up of a multidisciplinary staff, including social workers, psychologists, marriage and family therapist, psychologists, and health workers who have multiple experience with diverse populations. we also are a multi-link listed unit, which include spanish, cantonese, mandarin, vietnamese, tagalog, and russian. we also have other languages available with telephone interpreter services.

>> to give you a little bit of information, the child crisis services provides crisis assessment intervention and stabilization for san francisco children under age 18 or publicly-funded youth, a privately-funded, and uninsured clients. we are a 24-hour a day service seven days a week with clinical staff available at all times. we are a mobile service that response to schools, emergency rooms, foster homes, group homes, residential treatment centers, and we also provide services in our office, which is located in the baby. in addition to that, we provide phone tree not for many more cases. in the thousands. i did not have the actual number of what it was last year. we have a flexible service model so we are able to help lead people to what would be the right service provider for them if it is not us. some of our crisis assessments are assessments for youth who

might be experiencing suicidal ideation or homicidal ideation, out of control behavior's, or psychosis. violence is a major risk factor for mental health problems in youth, and we see probably about 70% of our youth that you have prior, exposure, oftentimes in their communities are experiencing ongoing trauma. in addition to there being post- traumatic stress disorder, we also see the present on going dramatic stress, which complicates any attempts at treatment. additionally, we provide, focus groups and the poorman group's in the school setting. we provide short-term case management and linkage to outpatient mental health services for youth that come through our agency, and this requires a close coordination

with the schools, with their primary care providers, and with mental health services. a lot of times, in addition to whatever the mental health problem is that they are entering our services for, they are having behavioral problems in the school setting, may be problems with truancy. they may also be having physical sentence, which may be related to anxiety sentence -- headaches, stomachaches, but maybe other things that are also not getting treated, whether it is asthma, allergies, or other complex medical issues. we utilize a family systems approach, dealing not just with the youth, but with the entire family and their entire support system, whether that is biological, family, or community family. in addition, we are able to provide psychiatric medication and evaluation and short-term medication management in which we are using similar medications to treat youth as are used to treat combat veterans. what we often see is that

similar to combat veterans, they have some of the same symptoms, but in contrast, where our combat veterans coming back are coming back here and are not in the same war zone, many of our youth are living in areas where there's ongoing exposure to whether it is family violence or community violence, which always makes things more complicated. quite a few of our clients are involved with the foster care juvenile justice system. a number of the crisis cases we see with kids that are involved with probation, that we see actually at the juvenile justice center at times as well, so those are really important pieces of what we are looking at. also in working with the schools, i think one of the things we see in addition to the behavior problems is there is absolutely an increased incidence in learning problems for kids that have been exposed

to trauma. if you are constantly focused on when the next best thing is going to happen, it is hard to focus on what the teacher in front of your class is saying and it is hard to dance to the next level. >> our other team, our crisis response team provide short-term and long-term individual support to families and community members exposed to violence. this is our team that response to homicide scenes were homicide victims are taking and helping the family to victim services, sometimes helping fill out applications or also helping the family with funeral arrangements, finding locations of where to bury their loved ones as well. the services are offered to families as well as to children. they provide critical services

as well as juvenile hall, people's homes, at our office, and at other programs as well. supervisor avalos: i have a question. occasionally, when there is a homicide or very traumatic event, my office -- we tried to help the victims in some way or another. is the best access point for us through crisis response network? sometimes, we actually help with arranging services for the funeral or fund raising. what is the best way to access to the family, would you say, for families experiencing extreme trauma? >> you can access our office, and we could help link you. the crisis response -- they use an evidence-based treatment model, which is cognitive behavioral therapy.

many of the clients they see -- most of -- 100% of the clients they see have been exposed to numerous traumas, which are similar to the struggles as the combat veterans. they continually are traumatized. it is chronic, ongoing exposure in their community. the challenges that we hear that our clients their fear of crossing different barriers to access, treatments to go to school, to go to work, in neighborhood communities. the way to access -- how we are accessed is for when there is a homicide, shooting, were critical incident, the police department calls us. we have a relationship with them where they notify us of the incident. we also get calls from san francisco general as well to access our debriefing services

and our ongoing treatment. you can call our number at 415- 970-3800. supervisor olague: you will be around later, right? i can ask you questions then? all right, i have a couple of questions. our final two speakers. thank you again. then we will go to public comment. among supervisors, i am kevin, and i am program manager in eastern and family community support department, working with the 15 wellness programs we have in our high school. as well, i am the point person for crisis response and coordinate support services 4 lgbt q -- for lgbtq youth.

first, we have to know the students who have experience, need a clear set of boundaries and a safe place to learn. we have clear commitments to safety and policies and procedures to keep our students safe in school. the second is we are employing a district-wide restored practices approach to addressing the areas of discipline. the third is we have research- based curriculum in elementary, middle, and high schools. the board is we provide direct services to our students on- site as well as professional development to support clinical intervention as well as consultation around students who are affected by trauma. regarding the direct service, we have 65 social workers at 80 of our elementary and middle schools. we have 17 nurses at 24 of our elementary and middle schools, and we have 15 wellness

programs, which is a collaborative effort with the department of children, youth, and families, and the department public health, and our staffing their includes a full time social worker, two five days, and there's, as well as a full- time community health advocates worker. i know you have questions for us later, and we will discuss more on this at a later date. supervisor olague: great. thank you. i am writing down a few questions now. sharon bell. >> good afternoon. san francisco family and children services was selected about 14 years ago as one of six national sites to participate in a federal program called green book initiative, which was also known in a complicated way as

the effective intervention in domestic violence and maltreatment cases, which really says that san francisco needed to come together with community partners, our public and private agencies, and understand the dynamics of how violence in the home impacted child abuse and impacts of violence on children. it was clear that we urgently needed to come together and try to collaborate inside our agency, outside our agency, and with our service providers. i am glad to say that in the 14 years, we have for the developed a great relationship with a lot of our partners so that we can collaborate on almost every case that comes up, especially those where there is police intervention. i think as we come to meetings and me quite a bit during the month, it is clear that everyone understands that children cannot be saved -- safe unless the

people who care for them can feel safe. we have used our green book initiative as a step to make sure that we provide all the kinds of services that children and their families need. for example, in child protective services, we have a training curriculum that is ongoing. we require 40 training hours in two years for every single child protective supervisor and worker, and as ongoing domestic violence, how you access services, etc. we try to coordinate delivery with our partners. we try to improve awareness and intervention. we have not only interdepartmental and community partnerships, but we understand that with the fast-moving different ways services can be

provided, we really have a lot of flexibility to make sure that as evidence-based services become available to all our services, we look at them and are able to interact and provide the training to make them part of our delivery. in terms of our internal policies, we do have a hot line and social workers with ongoing supervisors and managers who are on call 24 hours seven days a week, 365 days a year. we had a response time of 10 days or two hours. we really address whether a child is safe or at risk. we really work with the protective parent, and we do have mou's with many of the individuals that have presented today, foster care mental health, child crisis, police. we also have one with adult probation.

they call us when someone we have been working with has been convicted or is getting out of prison or jail. we work with the d.a. we work with victim witness, our resource centers, our multi- disciplinary interview, which we all for dissipate in. we also have team decision- making meetings and family team meetings where we come together and bring everybody to the table. the parents, supportive families, supportive friends, and agencies, to see if we can make a planned so that the family can be an architect of what is going to happen to their families. we also have, with recurring cases, we make sure that on each file, we have a purple star, so as the case comes back in and a social worker picks up the case, they immediately can recognize that this is a family that has previous or current domestic

violence, and in our referrals before social workers go out, it is in our alert so we always ask every single reporter if there is prior or present dv. five years ago, 40% of our referrals had about 45%. we are up to about 65 or 70% of every call that comes into the hotline reports some kind of domestic violence. i brought today our domestic violence liaison. i would like her to talk a little bit about how she works directly with our families. also, kathy baxter from the child abuse council who will talk about our child assessment there that is in the process of being developed. >> afternoon. i worked at the reilly center.

i would first like to thank you so much for having this forum open. there is a lot of passion in the room. i would just like to say that i am thank all to have the opportunity to collaborate with family and children's services for all survivors being exposed to violence. together, we strive to develop training, policy, and procedures that allow protective social workers to successfully and holistic we identify, assess, and intervene in cases of violence where a child maltreatment has occurred or is likely to occur. our collaboration seeks to improve the perception of domestic violence and child maltreatment with the families we serve. i say this piece because many times in the direct service i do, my families are very scared, very fearful, and it is nice to

be able to say that we're here from the community and we are working collaboratively, and if they do not want to talk to the protective social worker, it is ok, but can we explore alternate options? what can we do to create a safe space to enable the collaboration and conversation of safety? because the reilly center is stationed on site with protective social workers, we are given the immediate opportunity to intercept and provide services. many times, i can go out on up to four homes service -- home visits a day and provided media services because riley center is one of three domestic service agencies that has an emergency shelter, a transitional shelter that is up to 18 months, as well as counseling, support groups, and our consultants on site with cps family and children's

services. the one piece i would like to close with is that many times, what i strive to do in the training is remind all of us that we are planting seeds of safety and not harvesting crops. i think that is very vital when we see reoccurring families come in. we want to break down that shame, a breakdown any barriers and began to understand and conceptualize the barriers as to why survivors state. thank you for your time, and if there are any questions, i will be your. >> good afternoon, supervisors. i will be brief. i was asked -- sharon asked me to step up because the center is a nonprofit that has been around for 36 years. we are the lead agency for the sake start initiative, which works for children who have been

exposed to domestic violence and community violence. the other piece that i'm here to talk about is that we hope within the next couple of months to open a children's advocacy center and a center for youth wellness. i want to thank you for all your help on this. we're hoping to break ground and be open next year. april is child abuse prevention month. we want to thank you so much. i just brought you some awareness pins and some awareness information. it is also shaken babies awareness month. sitting closely to all the people we work with, as sources say that the work is multi- disciplinary. it is the public agencies and private agencies. we have a partnership. we work together. i started 36 years ago at the child abuse council, and no one talked about child abuse.

we had no protocols, no centers, nothing. when you look over what we have done in this community in 36 years, i think we should feel proud of what we're doing. we know what the problem is. we know what child, is. we know the work that needs to be done, and with your support, we can continue to advance and be a model for the rest of the country. thanks so much. supervisor avalos: i just heard that you were recognized nationally for your work in child prevention services. is that correct? well, congratulations. [applause] supervisor olague: i would like

to thank the speaker is again for all the information you have provided us with. i will go ahead and open it up for public comment. we will have questions afterward, so i thank you all for waiting and listening to all of the above. [reading names] >> good afternoon, supervisors. i like to just start off by saying thank you, thank you, thank you. i would like to thank the staff work on putting this hearing together. i want to sit first and foremost before i get started, we are talking about human life. over the last 10 days, probably, we have had in the african- american and brown community no less than about four homicides.

i want to say that we are standing here in honor of those lives. i will not talk too much, but i do want to fill in some gaps in terms of some of the content. this has been a very passionate issue. i am sorry that this chamber is not full. the issue we are focusing on today directly and tangentially impacts a number of your colleagues in a very direct way, and i would hope that this information to make it shared with supervisor cohen from district 10 where we have had a high prevalence of homicide, but also jane kim because we are starting to see more vulnerable populations move into district 6. having said that, i want to again validate that supervisor avalos and i have been on this walk many times. i would imagine even you today heard some new things in terms of our struggles and resources and the capacity to create what

we just heard is the national model. despite the continued prevalence of homicides, i want to say that children are at the beginning. we have to make an affirmative commitment to primary, but we also have to look at secondary and tertiary strategies of intervention. we have every single thing we need right here. that is the good news. i touch bases with my landlord just a minute ago as we were listening to this and said, "listened out. there is an opportunity here." in relation to this, we heard certain things, and i want you to think about this in terms of our developing strategy. one is poverty. poverty, poverty, poverty, and economic access to mitigate some of these behavior's. the other thing we heard was that there are geographic areas

of prevalence, and that is where mr. alvarez comes in. it is not his book is to be a social service model, but it is imperative that he have the resources to deal with mitigating these incidents on his property -- it is not his focus to be a social service model. the talk about intervention -- individual case intervention, but what happens is when somebody gets killed in sunnydale, because of the contiguous nature of the buildings, everybody is impacted. so if i am at 170 retail, residence at 172, 174, 176 are also impacted. we have to understand the way of getting to those kids who are exposed, who are not directly part of the crime scene but are

additionally exposed. last thing i want to say to you in terms of looking at this developing strategy is the continuity between families -- whole family systems, as you have heard repeatedly. you cannot deal with a child without dealing with what is in the family. we have to build strategies around the community. one of the things that might be helpful is looking at the role of our police as helpers' and as part of a community. supervisor avalos: thank you very much. >> if i could just say this -- in terms of the police, let's bring them home so they are integrated in the fabric of our community. thank you very much. supervisor avalos: thank you very much. >> i am with the village project. i want to thank you for bringing this to the forefront. we are experiencing right now

the end result of violence in our immediate community. i work with kids 14 and under, and one of the things -- the violence is so systemic, and it is multi-generational. for these little kids, it is embedded in their dna. i see it every day, working with the kids. just recently, the incident that happened last week in the western addition with the little guy was killed -- his little nephew is in my program. i always -- not always, but i realize when something violent is -- has happened, the kids go to school, and then their behavior, their personality is different. i have kids that you are doing their homework, and they just go into this trance, and you have to bring their attention back. all of this is the impact of

violence, and it has become so repetitive to them, that they have become sort of immune. to have a little 7-year-old kid having a conversation about violence -- where is your mom? she is in jail? no, she is not. she is dead. they have become so immune to this violence. yes, i'm happy to see such a forum being developed that the attention is being focused on that, but also, we have so many services available. i would like to figure out a way -- ellis is thinking, maybe we have a big bell with something violent happens, you read it, and all the services are sent into the city. we formed a coalition over the last few weeks around the current death in our neighborhood, murder in our neighborhood, but i want to see

-- and i want to invite the speakers to come out to our healing circle this thursday at new liberation church. we cannot just react immediately and temporarily because we have had violence in our neighborhood. it has to be ongoing, and we have to be able to respond and stop it before it escalates. the summer is approaching. the one thing about the violence that drives our shooters and that type of thing -- there is always retaliation. even in our community after the funeral -- i thought it was a block party there was so much going on. we need those services when they hear about it. how do we get them over there? to immediately -- it is just us right now. i would like to hear and see these people -- i want to see them come down and see firsthand because