parents contract to the top high schools. >> roll call vote for suspension. >> ms. fewer ms. chin mr. totiano dr. murase ms. mendoza-mcdonnell mr. monroe and mr. walton ms. wynns and commissioner president haney 7 i's. >> thank you now a there is a motion and a second for formally introduction of resolution. >> move second. >> we have someone to read the resolution into the record. >> yes. vice president walton i'd like to ask at that point to have our director the state and federal program and our lead director please come forward no

relation. >> (laughter). >> hi good evening so this item pertains to the current federal and state we were selected for the county and district this particular hem has to do with withheld top high school we originally got the direction from tdepartment of education didn't need an impact all of the schools have a policy stakeholder engagement this is a document that receives titles one upon review though, however, the reviewerer did say they want this written out so approved by the school council and substantial by the board of education

and that's from page 25 a or 25 to 25 e - very similar if not the same in the policy in impact for the rest of the schools. >> so the requested action to approve the parents involvement impact for the held high school to have the requirements of title one. >> thank you, colleagues and commissioner fewer. >> a clarification this is has been approved. >> title 15. >> thank you very much. >> any other commissioner wynns. >> i'm stumbled about this you look like you are too we've not done this it is because this is the schools their auditing or saying you have to so don't care

is the inclines supposed to be about every school not just in the district. >> what they give us direction the individuals at cdc understand the high schools are different so their recommendation was to centralize the funds the interviewer said we'll be more comfortable even though it didn't get looked at the title one funds but the formalized policy. >> and impact as any other school so it is simply we agree. >> okay. >> it seems to me an example judge compliance driven in sections that are unrelated to reality and actually improvement

are - you concur. >> thank you for the explanation. >> additional comments. >> mrifrn mr. totiano commissioner fewer dr. murase ms. norton mr. walton ms. wynns mr. haney 7 i's. >> thank you board member reports. >> standing committees report from the ad hoc on student assignments from april 2016. >> so we heard maine the issue of middle feeders to have spots for the feeders but looking at

language pathways and special education and the staff has a working committee they're trying to resolve a lot of the issues and present the process of their work and had a good dialogue and other committee meeting in may we'll discuss the annual report so the annual report had not come out but part of that is focused on the conversation about some of the outcomes of this year's student assignment process and some of continuing the questions issues that commissioners have. >> thank you president haney the committee as a whole we address to informational items one the school of the arts and task force presentation what the goals and wiener we what we'll doing do moving forward and the

comprehensive school counseling program framework in 3 year implementation plan presentation and that summons up the committee as a whole april 21st rules policy and legislation committee report commissioner wynns. >> we had most of report from the committee we had 3 informational items related to the board policies one of which we adopted tonight and one amended it is coming back and the third one was the item on the boards committee we asked to write different language about the select joint committee with the board of supervisors since this is not operating now based on the kind of decisions of the board of supervisors not to participate

we need that explained in the rules that was that we report also on the stacey act the other main thing the which is what we do at this time of year the activity of the rules committee to look at go legislation and so the board for the committee took a number of positions and we followed all of you have a copy of the documents we got from our lobbyist and if you would like to discuss any of those with them or michael davis the loan or with me we'll interested but also there are a number of pending things everything last friday we met wednesday evening and thursday evening e evening i think that is not our normal meeting night but the next day

what the bull deadline so their some things might be submitted but most importantly things are amended so forth coming to us none of the positions were controversial or will be anything that the members of the board will object so and also you've gotten the bill list before so you can compare those - the big bill list you got last month actually so all of those positions are available to you and so we'll be completing this and interested in input always into the members of the board or the staff has input into the - if they have opinions or experience with the things

before the legislator we have a group of bills not the teacher evaluation bills was a tape priority and the primes moving forward into this year it is suspected nobody is moving on that because of what is happening with our decisions so it is kind of a wait and see things thank you very much. >> thank you commissioner wynns budget and services committee. >> we have a meeting on may 4th i don't think there is any other report. >> thank you scomploern building and grounds and services committee. >> thank you our meeting last night and two items on the agendas one was the process timeline for the preparation of the thought bond proposal that we talked about a little bit of the timing of that so the

staff is going to be doing ongoing development for april and may the staff will have a final bond measure to the board on june 6th for the first reading of the bond measure schedule for the june 14th meeting it will come back to building and grounds and vote on it and have a second reading on the june 28th this last date to speed limit is august 12th and this is for the november 8th police the second amendment on the ballot an update on what what is happening on the c annexation with the planning to parks to the pavement to parks project think 42 avenue and so we have to see some of the pictures of the great temporary installations at the site some of the community déjà vu been going on they've been planting some of them other

community days to put murals on the grounds and putting in addition you know building the skateboard elements and have they're opening on may 7th i believe it is saturday may 7 and then from there starting introduce may 8 through the next two months of july the test period so see how everything is holding up and goes it is an exciting project and was moving along quite nicely our our next regularly scheduled meeting on may 23rd i believe monday. >> rem double check that, yes monday may 23 thank you commissioner mendoza-mcdonnell and once again action packed curriculum meeting this upcoming monday at

6:00 p.m. ad hoc on pencil matters relations date to be determined as well as the ad hoc school district and city college joint committee no other informational items no memorial adjournment oh, sorry. >> i have a couple of things to announce april 28th is at the opening of sfusd arts festival celebration 5 to 8:00 p.m. at the asian art museum it is free students exhibits we welcome you to the opening of the arts festival on the next date april 29th friday at 7:30 the san francisco school of arts annual staffing show may 12th to 15 will be the school of arts the dance performance at the theatre in the center and then finally may is market heritage month there will be an

events on may 14, 201610 to leveling e 12:30 at the san francisco main library in the lower level to celebrate olympian shooting for the goals for the asian pacific islanders offsite athletes thank you. >> on april 28th they'll been hosting they're after dark party if you have not been to one it is fun and the bayview and dog patch i want to congratulate you for turning 20 years old they and their grand slam finals were last friday and two of the students were in this they didn't win by were fantastic i want to thank mr. walton and partners that came out on

saturday for youth park it was fast to see young people playing in the park once again and to honor all the work at the park there was a tremors amount of history we don't 0 realize i went to school at youth park in the 60s it wnice to have a grea barbecue for ecology and love the community partners came out thank you for coming out and celebrating was is a great space we are looking forward to doing temporary development for the benefit of the community next door to malcolm x and once again we're going a followup celebration at malcolm x a

health fair and the reimagining pieced so we hope you'll all come out and thank you for your leadership on this commission commissioner mendosa-mcdonnell and student delegate i believe you have an announcement. >> the vote 16 is up for climaxed on tuesday mayor third at 4:00 p.m. i'd like to invite anyone who would echo our efforts into city hall as well. >> thank you a point of notice post in the agenda the staff report on acceptance of gives for the month of moss march 2016 no memorial adjournment tonight do you want to do that. >> we should - >> our president. >> we don't have the words to

do this we wanted to adjourn our meeting and honor prince he's influenced so many of our lives over the many years and several of us went to watch purple rain in the castro theatre he was an amazing icon and vision and just world talent so president haney you wanted to say a few things too. >> one thing i'll say which is related to the report that is, i was able to go to the elementary musk festival we hold every year and my comments to the students there were hundreds were there and hundreds and hundreds of parents as well i told them about one thing their probably wondering why

their parents were wearing purple but the power of music and what multiplications mean to us and art you know our students and entitled we him or don't know who he is or love music i think we will remember and appreciate how he not just inspired people to love music but be themselves what we are a school district we say love who you are and be who you are and inspire and pursue your passions that's who prince what it is appropriate we adjourn in his memory. >> and on that not i want to apologize i know some of you are here for the special order of

business we need to recess the regular meeting and go into closed session and convene immediately after our closed session we're hoping to get through that that in a timely matter to move forward with the special meeting thank you. we'll take minutes. >> thank you. we'll resume our session the report of closed session actions from the special meeting of april 19, 2016, the board by a vote of 5 i's and to absent commissioner fewer and mr. walton mandated the contract and to absence for one vaunt principal by the vote of 5 commissioner fewer. >> mr. walton approved the program for one program

administer and commissioner fewer. >> mr. walton absent with the probation and the status of an employee and the particularity of the d g versus sfusd by a vote have to i's absent commissioner fewer and mr. walton to the school district to pay up to the stipulated amount and by a vote of two i's commissioner fewer and mr. walton give the horticulture of district to pay up to the stipulated amount in the matter of marla versus sfusd the board by a vote of 5 i's absent commissioner fewer and mr. walton gives of authority of the district to pay up to the stipulated amount and that excludes the report of the action and the closed session on april 19th this regular meeting of the board of education is adjourned and now scott wiener we ha have

special cott wiener we have a special ott wiener we have a speciawiener we have a speciaer we have a specialr ww >> good afternoon and we'll call our meeting to order and the commissioner clerk will call the roll. >> clerk: rrk "roll call." i put the minutes in front of you. commissioner chow requested a

make a slight change on the top 6 page seven. i'll see text crossed out and other text that has been alded. >> commissioners, the revised or edited minutes are before us. for acceptance. so we need a motion. >> okay. >> i think this is minor and i can give it to you but -- >> go ahead. >> so on page 5, 5 of the ones that were in our packet. >> sure. >> up i number 7. >> okay. >> just to add precision to the language there because i asked how the stock would be dealt with regarding taxes at the end of the year. what i actually think i said was

how the stock would be valg valued for tax purpose. >> yes, i will make that change. >> okay. while we are making small corrections, page 6. previous page stated san francisco doesn't have a present coherent strategy. i would like to amend that that he would like to say -- commissioner repeat that. >> stated he would like p san francisco to have a coherent transportation strategy. >> yes. i'm happy with that. >> those are good changes that unless there is objection, we would add to the changes for the motion. any further clarifications if

not all those in favor say aye. all those opposed. they are approved. >> item three is general public comment. i see no one from the public here. we can move on to item four which is the report back to the planning committee meeting. >> so commissioner chung was unable to be with us today. did i chair the meeting and the meeting took up several items that the commission -- that the committee is recommending to commissions approval. and i'll go through that so that we can then act on the consent calendar following. first is a contract for the comtel technology that replaces the old button that is available in most hospital beds and will become state-of-the-art in terms of being able to have immediate

access to nurses if needed and does a number of other things telling the system what happening to the patient. so, it's a completely new system that is going to have a need for software maintenance and that is what this contract is for over the next five years. and that has been built into the anticipated budget for the general and so this is the contractor who will be the company that will be maintaining the software. so, that was the first item that we took up. we took up a second item from roma consulting and they will be helping to facilitate our planning session this afternoon. but has been awarded a contract

for working with the department over the next four years to create a lean process throughout all the department add you remember, it began at general. and they are now proposing that this -- it began in general in the year 2012. and there have been over 55 workshops already held under this process. and you've heard some of the work that has come out on this lean process and as i said, later this afternoon, we'll also then be getting a more throw briefing on the lean process and how it will assist our work. but right here, this is a proposal for the entire department for over a four-year period to be involved with and be taught and be able to carry

out the lean process on their own. they have proposed -- their proposal was forwarded to us at committee level in terms of the various subjects that they will take up on items and director garcia has assured us this is what they will need in order to make the department a lean department. and she will be providing updates twice a year on progress of contract and the progress of the department in terms of adopting the lean program and how it has been helpful to us. the committee does recommend approval of this contract. if we are unhappy this afternoon, i guess we could review that later. >> hold it until after? >> well, we thought we would ask for a approval and we can always ask for reconsideration. >> i would like to add commissioner to tell president

chow that the importance of this also is to try to build the capacity within the department so that we can lean our way away from our consultants as well. i think that is a goal for us then we have already an off of general tha that we'll build upon for that need to hold on to the services if it should become institutionalized into the department for the future. >> very good. in our conversations with the company, company has been involved with a number of organizations in terms of health care, not just at hospital levels but health systems and pertinent to us is that they were working with [inaudible] health system and the hospital and the c.e.o. there who will soon be our c.e.o. at s.f. general. this is a tool that would be one

in which the department would then be able to move forward if their planning processes. the committee does recommend approval at the commission level of this contract. the remaining contract actually has to deal with working to understand all of the assets that we have real estate-wise on the s.f. general and laguna honda campuses. as you have read, the contracts themselves, they actually have describe the number of buildlings if we just stick with s.f. general, it's almost inclusive of all the buildings that have not either been studied recently or have been filled and that includes the ones that are enumerated. the buildings are being looked

at for four different purposes. that is whether administratively or either biomedically or for housing as far as uses and so, the four contracts are needed for the -- with the different architects who have different expertise in particular, the two contracts that sound like they are working on the same buildings. m.e.i. architects and l.d.a. architects each have different expertise. and so, they will then be concentrating on those expertises in either housing or in terms of looking at the clinical or biomedical use or administrative use. that report will be combined as an s.f. general report.

as laguna honda wha they'll look at the back builds that are currently vacant and to whoo availability, how can they be used in these areas also that we've just spoke ton. this is in preparation for the potential of another capital bond issue in 2022. but this would then give us a reasonable inventory of what this department does have available in terms of available space that they are going to be needing in order to carry out all the duties they have and you will recall also that we're going to have to one day do something with our building here and therefore vacate those services from here also. so this will be an important aspect of looking at how, then, and what capital needs we'll have in the future.

so it gives us that background so we know where we're coming from. so the committee is also recommending the approval of these four contracts for this purpose. that ends my report. dr. [inaudible] was kind enough to join. do you have anything to add? >> no i would endorse all the contracts as prudent and reasonable. >> if anyone has any other questions regarding this, if not, we can move on to the next eye testimony. >> next item is the dleand contains all the consent challenged review. >> the calendar is before you. if anyone wishes to extract any items, otherwise we're prepared for the vote. seeing no extractions, we're prepared for the vote. all those in favor of the consent and her calendar say

aye, that is passed unanimously. >> item six is a resolution recommending that the board of supervisors accept a gift of 2,625,000 from the san francisco general hospital foundation for equipment, procurement, for the priscilla chan and mark zuckerberg general hospital and trauma center. >> >> mr. martin -- sorry. >> that still happens. >> boy, was that sometime ago! >> craig wagner chief financial officer. the resolution before you is the latest request to recommend to the board of supervisors to accept and expend funds from the san francisco general hospital foundation for fixtures, equipment and high tea he new

zuckerberg general. it's been engaged in fund raising campaign to bring in private philanthropy to support the effort. it's been very successful. the commission has a proofed today $58.4 million of accepted gifts as associated with that effort. this we've been doing them roughly twice a year. this is latest installment. we try to september gifts on a relatively regular calendar without coming to you constantly. the program is going very well. we're on track and spending the money and managing within the projected budget so we're happy with how things are going, thp help us keep the dollars going out the door. and finish up with expenditures and also carry into the early months of operating the new

hospital. the resolution before you, if you approve it, would be a recommendation to the board of supervisors who would actually pass a resolution accepting the gifts so we're asking for your support for this resolution today. can happy to answer any questions. >> thank you. commissioners, the resolution -- is there any public comment? >> i have not receive ned requests for this item. >> we're prepared for a resolution that is before you. if we can have a motion. >> so moved. approval of the resolution. >> a second. any further discussion? >> what are we doing to celebrate the people at the foundation who are continually generating funds for hospital? it's unbelievable to have these kind of people in our community. >> absolutely. it's been an incredible effort.

we've done a couple of things. we did have at the board of supervisors and at the health commission particularly at the first installment, we gave acknowledgment to the board that has been active in raise being the funds. there was an event at the new building. it was in november. there was a thank you and honoring of the donors at the actual ribbon cutting ceremony for the new hospital that donors were and the board of the foundation were acknowledged extensively. so we really have been trying to make a point of what -- it's not just great for the hospital but great example of how private philanthropy with can work for public hospitals. we're trying do as much as we can. there can't be enough.

>> and to let you know commissioner singer that dr. chow and i took them to lunch and presented them with awards, the exiting chair and to amanda heras the executive for the commission. anything else we can think of, we would take into consideration for that. >> we need them. >> we need them and we -- >> we'll have further projects. >> we sat with home to in their strategic plan as well and we're meeting with them on a monthly basis, greg and i. >> keep them ingrained in what we're doing. >> exactly. >> i'd like to thank our own commissioner sanchez for representing the commission. i'm sure that's no small thing. >> i would add that again, this

is separate pertaining to these materials and supplies that would not be in the budget under the city contract were picked up on the radar a couple of years ago. and as we know, many of the donors wished to be confidential at that point in time. in order to move forward on this. but as stated, there are now numerous public thank yous pertaining to the unique leadership. bear family and you name it. all have been within their own zones been honored. there was another event which was sponsored by the art commission to thank many of the donors who had been in the arts and served and donated to this where the artist and the community were invited to look at all the different levels of arts and whatever.

it was well attended and there was much thanks given to the donors and the artists and it was really extremely well done within the context of how, in fact, they wanted to be thanked in that context. so there is on going events. but in essence, the whole purpose is how do we support -- i mean how does the foundation support to provide these resources to maintain the excellence and training of san francisco general and young, old, two and three generation foundations. it's astounding to see commitment there. i just want to say i concur. it's an on-going communication and dialogue and something that will be there and it was a safety net when many, many years ago, we were worried about if the seawall was going to collapse and they came to our aid and have continued to come

to our aid. we want to make sure that that is a continuum of support for us. sfghs. >> i found the leadership extremely dedicated and was pleased to be able to work with them and we'll continue to have opportunities to work with them. > them. so at the resolution, we've had discussion. are we prepared for the vote? all in favor, say aye. all those posed, resolution has been passed unanimously. thank you very much. >> thank you commissioners. item seven is creating healing organizations in a regional system of care. >> good afternoon. my name is lynn dolce.

i'm the directer ffer for foster care mental health. one of the trauma inform care initiative which is what we're going to talk about right knew. get my glasses on. >> it's right in the middle of the screen. >> this one. thank you. >> you're welcome. >> there are my notes. can you get them. thank you. so on behalf of director garcia and our team, with the trauma initiative system of care. i'm grateful for the opportunity to be before you today. as you know, or may not know, but i probably do know, the trauma is the number one public

health concerns we face today in the county. trauma and toxic stress have been linked to many adverse health outcomes including diabetes, heart disease. lung ailments. cirrhosis of the liver and suicide. trauma impacts more than the individual. it has a ripple effect on our communities. as such, at the department of public health has steen that a need for a preventive, collective, collaborative approach was needed to address trauma. we're used to thinking of trauma as a behavioral health incident. we think about ptsd and trauma in young children. what we know is that trauma impacts entire communities mostly disproportionately to communities of color, particular lit african-american community and latino community here in

this county. and when you add racism, bigotry, poverty to the issue of trauma, you get a toxic brew. that's what our clients and patients are coping with on a daily basis when they come through our doors in the department of health. that's what our staff is coping with. i think the reason why this paradigm shift is happening now is because we realize that we can spend and we have spent lots and lots of money on evidence-based practices to address trauma on an intervention level, one o to one intervention level and even family level, until we have a system that's a healing organization, it's just a practice that we do. i could be the best well-trained therapist in the county, as long as my patients are experiencing trauma and stress,. my hour with them isn't going to

hit the mark for our patients. we're looking at organizational change in addition to practice improvement in our offices. the ideology of the project was really in conversation with director garcia. realizing that we had a lot of work do that our staff was suffering. that we weren't really hitting the outcomes we wanted to hit. as we began to take a deeper look into why that was and is. it became clear that address trauma on an organizational level was something we needed to do. so we developed the curriculum, we call it trauma 101. this is a curriculum where every employee in the department of health, all 9,000 of us will be trained in a basic, fundamental training around what is trauma and how it impacts us. in addition we developed trauma-informed principles that we can begin to look at how to integrate organizationally

throughout our department and developed competencies around the principles so we could measure weather our organizations are making the change and how is that is impacting our staff and patients and outcomes. really, our method is to teach, to sustain and support and study how this is impacting our organization. sorry. just hitting "next." thanks. okay. so relationships matter. they rule the world. big business, corporate america, and even in the department public health. how we feel about each other makes it a difference in how we do our work. in order to become a healing organization, we needed to talk about three things in an open way. talk about the centrality of

relationships and healing. the way in which trauma can destroy relationships and how intentional leadership can combat the trauma on our delivery system. the problem is when our delivery system is siloed and fractured. when our organization is reactive, when our leaders become numb, the service delivered reflects that system. relational leadership is something that in the trauma 10 is training that we deliver to all the staff is a key message we're trying to impart to our staff. so instead of having a reactive, numb, fragmented isolated system, we teach our workforce basic information that has the potential to dhaipg change the way they think about their work

and interact with each other. the shared knowledge and language of trauma within our workplace is a place to start these conversations to really lead the change. a core message of our work with our staff is unifying our system. we can't make meaningful lasting change in our silos. we have to come together and learn how to collaborate. we've developed a local approach and now we have a regional and national approach for what we use this in this county. as you know, we get hurt in relationships. it happens all time. it's the nature of relationships. but we also heal in relationships. if the symptoms of trauma live in us as individuals and i would argue as well as in our workforce, many of our workforce have grown up and lived in san francisco and have been exposed to chronic stress and trauma throughout our lives. they're now our employees and ask them to serve the community

which they grew up in. it's a wonderful thing. i think sometimes it impacts the way we can deliver our services. we understand trauma not only now from the individual level, we've got good neuroscience behind what we understand how to help people. we understand our staff is made up of people. we understand also that our job as providers in the department of public health -- our tool is ourselves. if as people, we're not in tune with ourselves and people around us, we're into the going do our job well, how we relate to each other does make a difference. our administration is really important hererc1 because witht supportive and intentional leadership as a mentioned, we can't sustain this going forward. we have a model which we'll talk about in a little bit which includes leadership development. even as far as our funders go, when we're vying for funding many of us do the same work in this very small county.

we're competing against each other. we're competing against people we should be collaborating with. so even when we talk on that level of how do you collaborate. how could you make one door "the" door rather than having our community go true different doors. our funders have something to do with that as well. we think the principles of the system can be seen as a patd into this kind of healing organization. so we know where we are, we're in this trauma-organized looking system. you can see that chart is really kind of chaotic. trauma impacts our organization in ways in which we get confused about our roles, the hierarchy gets confused sometimes. people get isolated and fragmented. where are we going? we're going to the trauma-informed place where we can begin to have a shared

conversation around what is fundamental to the shift. and i think what we know is that a trauma-informed system is the first step. whawe want do is be a healing organization because that's our job in public health. to help people heal. we want good communication and collaboration. there is not one way to make a trauma-informed system. this is one way. if nothing else, one of the core messages of the three-hour training that we with our staff 100 people at a team is asked them to shift their perspectives. we're very, very used to asking what is wrong with people. what is wrong with you if you're upset? what is wrong with you if you have an ailment if and you're in primary care? when you ask that question, you locate the problem inside the individual. wie teach our staff that trauma

is an external event that happens. we have our reaction to it which has a physician logical reaction to our brain. if ee stick with what is wrong with you, we don't get to this idea that we can be curious with each other. really, shift the question to what has happened to you. when you shift the question to what happened, you create less judgment and create more openness. then the person can tell you their story. providing context fosters compassion and helps us see our strengths as a community. the evidence-based practices i referenced to begin with are part of this model on your left which is that our system sometimes functions like a machine. and really, we're not a machine. we're made up of people. we're not really doing output. we're not -- it's not about output. it's about outcome and

relationships. in our mission is to ultimately serve and protect people by working with people. if we know that people are unpredictable by nature, how do we account for that? slowing down to see and understand the humanity of people we work with and acknowledge that people are doing the best they can with the deck of cards they're dealt and deal with that in the department of health. we want to understand our system and department as a living organism where it gets nurtured where leadership like the soil and rain and rest of us, the branches spill out and do the work we need to do to have our communities flourish. we're working on this picture here. we think that building a healing organization is included the

foundation, obviously. you need a roof and you need the structure. bear with me while he work on this. here is our foundation. we have six principles i sent to you last week -- or that mark did. thank you mark. two are trauma understanding and culture humility and responsiveness. those are foundational to any organization looking at trauma. the other four principles that you see rl the pillars that hold the walls up and the foundation stable. so a what's inside the house is all of our trauma-informed care practices, all the interventions that we spent money training people on. if ear' training people and they're doing their job well with our complients and patients, if they go out in the haulway and have a terrible event with an assistant, people

can't continue to function that way. the furniture i be side is protected. our evidence-based practices need to be protected by the overall structure which teaches each of us how to hold it so healing can take place. we think our t.i.s. curriculum aligns with other initiatives that the department is pursuing at this time. racial humility and trauma-informed system are almost mirror images of oach each other. they're both looking at who we are as human beings and what we bring to the work is valuable and how we can sometimes get in our own way and each other as way. i think that when we apply both the lens of the frawm-informed lens and racial humility lens to collective impact and lean, we'll have an environment that is conducive to the healing and

growth we're looking to achieve in the department. here is our slide on how we're doing all of this. so teaching, we've taught over 3,00 3,000 employees so far. how did we do it? we started out with two master trainers myself included and trained two other master trainers who have trained a new cohort of trainers. the idea is to build sustainability from within so we can do it within and we want this embedded in everything we do. queer' teaching each other how to do the work. we're training people who have interest in in this work. they're not necessarily teachers or leaders. as we define them, but maybe they're clerks and maybe they're people who really have lived experience who work within our department and just want to

spread this word. so, this cohort of next master trainers or trainers are a varied group of people within our department who come to this for very different reasons. we wanted the message to come from all levels of leadership and staff for this training. so, that kind of speaks to our sustainability plan. we are embedding the knowledge within. we are on goingly training people to train and we have champions in each area of the department that are looking at how to embed these principles into organizations. we have a leadership cohort that includes the director of maternal child health. our population health director. director of c.y.f. director of laguna honda and pleaders from first five and j.p.d. these leaders get together and

through a grant are creating a leadership tool box create leaders to embed these principles into their organizations. we are meeting with the people who are involved with lean racial humility and collective impact to make sure our curriculum jives with what is taught within the initiatives so staff is not confused with what they're hearing so it all fits together for people. in our evaluation at the end of each training, every person who takes the training fills out a two-page form and let us know how they think and doing and making the commitment to change. we evaluate how well people are in taking what they've learned and make the small change we've asked them to make. we tell them to tell us what the changes they want to make and we follow up with a phone call and e-mail two months later to find out how they're doing with their change. and i think i sent you some of

the outcome data. we can look at it. i won't spend too much time on that right now. this is just another way to show you how we're rolling it out and what the multilayer approach is while we val ute principles, we think it can be difficult at that transform the concepts into specific behaviors that meet the needs of the clients. self-assessments. when the staff are done with the survey, self-assessments can serve two or three purposes. they help to identify and evaluate are the program needs. but they also raise consciousness for people b about what they need to do to create growth in their own organization if they're reflecting on what they want to look at for themselves. every component of the evaluation is about transitioning the knowledge into action.

and -- i don't want to repeat that. okay. okay. so this will is a little bit of what we learned. that while most people approve and agree that this will is a really important toopic for them and think it will change their work experience and the way they work with clients and patients, they are worried it's not going to be easy to apply and they're really worried our leadership is going toe abandon this initiative that it won't get the support it needs and will be poorly implemented. we're taking the information to heart and focusing a lot on our leadership development around these concepts and how to really embed this and provide support for our workforce. i'll end with letting you know that we've now been recognized nationally by sampsa in order to take our model and make it a regional model. we're the lead department in six

county-effort to create a regional approach. why does a regional approach matter you might ask. why not just know cuss on san francisco? it matters because one out of five of our kids in child welfare are placed out of the county. placed in the sister counties. they're mostly impacted by trauma and they're the least likely to get trauma-informed care when they walk through the doors of other clinics in other counties. 65% of our kids in san francisco are placed out of the county. there are fault lines in between our counties and kids and families fall through the cracks all the time. there are so many barriers to care. by bringing all of these concepts and people together, including funding streams and leadership development, evaluation and research, marketing by really taking this lens of a trauma-informed regional approach, we are really creating a shift in the way we can do business across county

lines and the ways our families can seam leslie move. they don't stay in one place. they might live here and go to school somewhere else. we need to serve them as one. we are disseminating the trauma 101 curriculum in different counties. they're training their own trainers. they'll have their own master trainers based on our model and we'll work with them over the next few years. we're looking at all the initiatives through the trauma-inform lens with our partners and counties. if you have any questions, identify a be happy to answer. >> any public comment? >> clerk: i did not receive a request for this item. >> commissioner singer. >> thanks for coming. >> hi commissioner singer. >> at least i'm coming to this fresh. i had two questions, one is, if

we were in a training session, what would we experience? like trying to make the concepts which you live and breathe every day more tangible? >> good question. so you would experience a three-hour training with a couple of breaks. maybe some coffee. and we would go through these principles that i sent to you, the six principles and we would help you understand why this understanding of stress and trauma matters to you individually and why it matters to the patients we care for. we'd go through neurobiology. this a training for every single person in the department of public health. we worked on the curriculum to make it really user friendly so that everybody in the department could understand what we say when we mean neurobiology, what the heck are we talking about. you'd see simple pictures of brain. we'd explain brain development

and explain the stress response in human beings. we explain things in a simple way and ask people to reflect on that. we move through that in cultural humility and difficult examples, talk about racism and poverty. >> can you give us an example? one of the things you might talk about? >> yes. i'm trying to think of the one that maybe is pertinent at this point. so until the shift your perspective slield i showed you, that comes in when we talk about relationships and when we talk about how important it is to stay regulated at work by this time in the training, they understand what regulation what it means to be self-regulated. we talk about how an example would be that will i am really, really functional in the morning. i get up, i maybe go for a run.

i have an appropriate level of stress. i'm very good in the morning. i get my e-mails done. if you work with me, you'll get phone calls from me in the morning. by 12:00 or 1:00, i taper off. if you give me a deadline within 24 hours but i have two on my plate, you'll see in moo a market dedplees my ability in the afternoon. i will have gone over the peak of my stress level and i will be become slightly dysfunctional at that moment because i'm confused. i have a stress reaction physiologically happening. i can either stand in front of my computer and think it's going to happen somehow or i can take a break or i can go to a coworker and i can say i need some help. my boss sent me an e-mail, i have a deadline, i don't know what to do, i need help can you help me. the coworker can say let's think this through together.

that's how relationships matter. that's how i need to stay in tune with myself and know when to ask for help and how to get help in the context of my day at work without calling in sick the next day. we want to look at what keeps people coming to work and what keeps them productive and work no coming to work and being at work but actually working at work. another example around the cultural humility piece is we take a look at the very high instance of health outcomes in our residence in the southeast sector of the the city. we understand that for various environmental reasons people are suffering with asthma many times more than other people in the county. in bayview and how do we understand that from a cultural -- not a cultural pe

perspective but racial perspective. how do we have the discussions on whoo is contributing to this? how can we help this community. we can provide in-home visitation. asthma treatment but how do we have the conversation that racism matters. cultural responsiveness matters and when i'm stressed out, i kind of go to my cultural center versus being able to stay intuned with the person in front of me. if you say something to me that triggers something, you might not get the best response from me in the moment unless i can see wow, i'm triggered. give me a minute, let me come back to you. you might get more of my east coast italian girl attitude versus what you're saying -- you're hurt, what can i do to

repair that. we're teaching them tools of how to commune cailt. a great example is called pearls, it comes out communication excellence which came out of the american medical association created for surgeons. mostly because surge pes had a hard time connecting with patients. they were excellent in surgery but follow-up questionnaire was difficult. pearls is a communication technique we teach and what the feedback we get is that a lot of the clerks and people at the front desks have now laminated it and put it on their phone so when they get phone calls from people upset, they can refer to it way of communicating with people that keeps them engaged and in the conversation versus triggering the person who is already upset on line. the feedback about that one piece for people who answer the phones has been phenomenal.

it's been life-changing for us at work. that any now how to field a call from awn set client or patient in a way that feels professional and that they have their integrity still. >> thanks. when you're finished with the department, if you can do it for the u.s. airline industry, that would be helpful p. >> anyone in particular? the whole thing. >> it's beginning to sound like they all need it. this is -- part of your description here sounded more like within the employees a stress management process. so where does the word "trauma" fit if as versus why this wouldn't be sort of considered more a stress management to your environment. >> because our staff experience a lot of secondary and vicarious trauma throughout the course of their day by serving the

patients we serve. at sfgh, in 2005, we knew that every kid coming into our department of psychiatry by 6 had several exposurers. they're 16 now. four traumatics exposures by the age of six. those are our patients. when we treat them and when we provide services to them, there is a level of secondary trauma that we experience when we hear their stories over and over and over again. this is true for primary care. this is true for i.c.u. and true for anybody working in the department of public health that has patient interaction. that level of stress gets translated back to the client. it may get translated back to, you know, i can't hear this any more or i can't return your phone call today, it has to wait until tomorrow. there are various ways we see secondary trauma and vi

vicarious trauma showing up in staff. there is a stress-related response that not only our patients and clients experience but we experience. by teaching the staff, really teaching them about why this happens, that it actually makes stens that they're feeling the feelings and the behaviors make sense, we believe that we can just like we do with our patients when we teach them cognitive behavioral skills we believe we can help them change their behaviors by understanding the nature of them. they're not bad or wrong. they don't need to quit. this is a normal response to a stressful situation. >> so in your survey, it appeared that one of a problems here is that they're saying it may not be easy to apply in their work. so the concept -- i think the

only other patient -- i understand. we should become aware there may be trauma in their history and like we are supposed to be doing, we should be aware that there is trauma that is really important to understand how somebody is responding to us. i'm trying to understand your employee program to say and also then how do we get around it because it sounds like they agreed this is good and i need to try to do what you just said in the mid afternoon, that it sounds like it nay not be very easy to do. how do we then work on what were those problems to allow them then to get back on line so to speak. be willing to take the phone call and so forth? >> i think part of it is the way we construct our policies and procedures from the top down. we have a top-down way of doing things which is fine, it works. biew we need a bottom-up

feedback loop for people to participate. a lot of people who take the training say i love this, but i director would never let me do this. can i couldn't do this at work. how is it that some people can, you know, take time and do this and others can't? so i think if we think about -- there is a -- how do i explain this, i'll just say it. people are afraid. people are afraid to peek up, speak out, have hard conversations can they're afraid they'll have a negative performance evaluation. i think it's up to us as threersd think about how we can make people feel safe. there is a concept, the key principle state of and stability in training which we talked about how to create a safe work environment that goes for physical safety as well as emotional and relationship safety. it means you can go to your supervisor and say, wow when you

said that i got angry. is it okay for us to talk about that. we learn about this in racial humility that people in power have to make sphais for people on the downside of power to have the hard conversations. i'm not sure i'm answering your question exactly. so help me if i'm not. keep ask asking because i want to clarify it for you. >> maybe i'll ask director garcia. if that's the feedback that is needed, do we have mechanisms or is it your vision of this process that there would be that bottom-up without consequence in terms of i'm really afraid of my boss or whatever is the impredments withi -- impediments for making it work? >> part of the work that we have to do is we trained our first

3,000 people so we have data to look at. it will be our responsibility and this is part of why we are looking at how we train trainers so we get deep into the organization. then probably we'll have to look at how -- once you have trained everybody, everybody understands they have permission to do this. then it becomes is there a policy that we can develope develop for that? is there a practice we can may go sure our executives in leadership, we have an integrated steering committee. we have to keep working at it. this a new process and i want to remind the commissioners that who we serve rl the most traumatic people in the city. in fact, we have run the trauma center. go all the way down to outreach workers. our homeless outreach workers who went through a traumatic event. this last couple of weeks. this will is such an important

tool for our staff. and for us to understand how to support them in supporting those who are traumatic. what i've watched is those that do the most trauma work become difficult employees. and i have an experience where i brought many of those employees together and quite frankly, our human resources said they're problematic employees. did we create them? or did we hire 20 problematic employees. i would say latter is true. because of the trauma they're dealing with and we're not dealing with them, this is one of the reasons in all of our work we're doing, we are rae trying to provide people support like debriefing those who do some of our emergency response pieces. we're learning as we're doing and that's a great question because we have this set up a mechanism on how to enforce

this. that's why we're doing the inspire department and not just half of the department, not just a third of the department, not just the hospital, every single employee. as they come through the employment process with us, this will be one of the required training they'll have to go through. >> we train the entire department of human resources in october as a whole. they came which was amazing. that they had an entire fle hours together to sit and hear this together. and now they can take it back into their various meeting structures and begin to imcomplemen implement some of the concepts they learned about. >> we serve a a large proportion of the african-american community as well as the latino community in our services. if you stretch that out to our community-based organizations, we serve a lot majority of the population in the city who are facing traumatic events in their life river day. i thought ---if you can give us

part of your background because we're so lucky to have you on staff. we started this in foster care. if you look at foster care children, 50% of them become homeless as they become adults. to think about how we're serving our foster care children is a reflection of how well we are doing in nie opinion as a department and how well we can help the families of them. and one of the biggest goals that we've had in our foster care system is to try to get them back to their families. if you can tell us a little bit of your background. >> i finished 16 years at san francisco general hospital in the can't of psychiatry for children, need and families in partnership with pied tricks. and have long been committed to serving our population that we serve at the county level.

from i taught -- i teach at u.c. i'm on faculty there. a few years ago i had the opportunity to become the director for foster care mental health. i came to d.p.h. prior to coming to d.p.h. i was talking to director garcia and colleagues and how hopeless i felt like as a provider because all the hours i spend with the families and they go out and report another exposure to a trauma, i really began my colleagues at the hospital to think about what was needed to help our families in this preventive approach became more and more appealing and this way of looking at it organizationally because i knew how i was feeling wasn't because i'm not a good clinician or dpoant know my job, it's a problem with secondary time

advertisation. we need a public health perspective. how do we do this? you know, director garcia and the director of children, youth and families reached out and asks my colleagues and i to take curriculum we wrote for san francisco unified school district which is called healthy environments in response to trauma in schools. and adapt it for public health. that's what we did. we had been in san francisco unified school district since 2008 doing very similar work with teachers, nurses, social workers and leaders. at that district level. we were able to take that curriculum and adapt to a public health perspective. in foster compare mental health right now, the work with child welfare has grown to include a deep and robust partnership. it's really an example across the straight about how it's the

only -- it's like a hybrid we share funding 50/50. it's 50% funded behavioral health and 50% from child welfare. there is a cla collaboration there. bringing the children home and bringing them to their family is our mission. and making their families ready for them is also our mission and those are the families those adults we serve them in all our clinics. those are the adults we serve. >> car commissioner karshmer. >> i applaud you doing everybody not just a few people. findinfinding that 2.82% are corps yid this isn't going to happen. do you have thoughts on what contributes to that and -- because this is hopefully truly a cultural change. >> yes, definitely.

>> horizontal work across the drpt department. what kind of things are you envisioning to help, you know, address that and is this indicative of the lack of trust? >> it is. i think the people who are reporting that they -- we have initiatives to teach here in this county. we see things come and go for 30 years. i've worked for 25 years in this county and so many initiatives and great ideas. creative ideas that we have invested in, worked on, train on. and they come and go. sometimes that depend on leadership. we can get a new director of public health and this could be gone unless you think it's so important it doesn't matter who the director is next. part of it is that that things come and go an people are fatigued by that. you can see them