she told the whole class, she came back and told the whole class this was a huge day for her, just as big as the day when she was 15 but today she felt empowered. she felt like she knew what happened to her and she finally put a name to it and said after that class she wanted to go get therapy. after that presentation, i definitely talked to her, we exchanged social media, we are still in contact. she wanted to make sure i said her name, maria cruz, she wanted me to share this story for her. education and prevention is so important. i could have been that 40-year-old woman. i don't know where i would have been today if i didn't have the professors i did and the classes i did, and if i wasn't able to do the job that i do. i could have been her in that classroom. prevention education is really important. support around that. i was able to refer this woman to resources, which i could,

but i didn't have a contact i could just give her, we know that is so important for people seeking services and at that point in their healing, so thank you. >> thank you so much. thank you. >> hi, good morning. i'm julia weber and i am a consultant and adjunct professor focusing on domestic violence and sexual assault in san francisco. i want to commend all the speakers who have come before me, and also you for having this hearing today and addressing the issues. i am also the former consultant who staffed the safer schools sexual assault task force under the department on the status of women which the board of supervisors had the foresight to establish in 2016. so that was ten members representatives from our city agencies, as well as survivors and we spent part of 2016 and

all of 2017 developing a comprehensive report on sexual assault in san francisco. focusing largely on higher education, on the colleges and universities and what they could do. but as the legislation required, we made recommendations for what the board could do to improve how the educational institutions and how the city handles sexual assault. we had 47 recommendations in many of the areas people have addressed today, prevention, education, transparency, evaluation, collecting numbers, improving policy. we had two over arching recommendations, and one already eluded to, which is to have an ongoing task force, an entity that is staffed that focuses on sexual assault in san francisco. to ask the colleges and universities or k-12 to be more responsible for sexual assault than the larger city, seems to be problematic. we got that response pretty consistently.

that even if they are committed to the issue they need the support and the coordinated community response. we know what works. san francisco is the first and only city, as far as we know, in the country to have that kind of leadership in the city government level to say, hey, what can we do as the board of supervisors to support the educational institutions doing the right thing. so building on that and not losing all of that momentum . we took lots of public comment and input from sur visors. survivors, we heard a lot of what was said today and in the community. it's not new information, but we know what we need to do. and that report, i'm hoping, could be a baseline, a place for you to look for recommendations, so that we could make the difference that we know needs to be made. we know intersectional issues are so important. the experience of race, immigration status, gender identity, sexual orientation, all play a part. so i appreciate you taking a

look at the report. i'm sure you have already, but to continue to rely on it and get the kind of input from that good work that i think those members and all of us did. so thank you very much. >> hello, everyone. my name is lesley simon. i sat on the task force that julie just spoke about. also founded project survive at city college of san francisco. i'm so proud of alice for her testimony today. prevention education is what i will focus on this morning. i'm inspired by the courage of survivors who have always taken the lead in the work for getting justice for this crime that disproportionately affects women. abbie wells wrote to rosa parks who protested rape in the early days of the civil rights

movement, to the women of the 1970's which gave rise to rape crisis centers across the country, to the brave survivors who have come forward today. these are the voices that count. what project survive can offer is education and training to service providers. we are committed to the goals of transformative justice. yes, we respond to crises like the one being heard today but also where we promote structural and social change and value community accountability in addition to perpetrator accountability, where legal and health service responders and providers are committed to an anti-oppression framework, political, economic and social oppression where they work from a trauma-informed survivor center perspective. one of the rampant stereotypes about rape survivors is the crime perpetrated against them was their fault. that they did something to cause it. they could have made better choices to prevent it. to blame the survivor dismisses the seriousness of the crime,

shifting the responsibility from perpetrator to victim. i believe the stereotype is at the core of the failure to acknowledge the severity of sexual assault incidents and failure to conduct effective investigations. project survive, one of the key lessons is the only person who could prevent rape is the perpetrator. another key lesson is most rapes are acquaintance rapes, though they are harder to prove this is not a reason for them to be dismissed. i hope whatever solutions come out of today's hearing, they include a citywide prevention education training program for service providers and responders that is trauma-informed and survivor centered. where investigators understand how trauma often produces fragmented memory recall where providers respect surviveors needs and choices. with the citywide effort that includes education and prevention, san francisco can become a leader for the rest of the nation. >> supervisor h. ronen: thank you.

>> good morning chair sheehy vice chair ronen, supervisor peskin. i'm here with many of my staff. i really want to thank supervisor ronen for opening up this hearing and i want to acknowledge chair sheehy's commitment to end violence and violence against women in particular and to supervisor stefani to end gun violence. with your leadership i know we could get to a survivor-centered solution. we have distributed the school sexual assault task force, and have a copy of the highlights. i hope you will have a chance to review the 47 recommendations. and the top recommendation is as jane manning stated, a

coordinated city response to this pervasive crime. so i look forward to working with each of you on getting to solutions. i did just want to mention mr. espinosa talked about the challenge that sex workers have when they go to police because they are victims of crime, they are raped and robbed. we worked for the last 18 months closely with the community to bring to the police department and the district attorney a policy to prioritize the safety of sex workers so that there is now a written policy at the police department and district attorney's office that will treat the emerging crime and not the fact that these folks are engaged in sex work. i really attribute the leadership of chief scott and district attorney for this policy. thank you very much. >> supervisor h. ronen: thank you. next speaker?

>> good morning, supervisors, and thank you for your leadership. beverly upton, proud to be part of the san francisco sexual violence consortium . what if we formed a team from the day the survivor reached out? what if 9-1-1 believed and formed a team that second? the dispatchers were well-trained, knew how to speak to survivors and started to build the team right away? what if the responding officer then joined the team, believed the survivor and started to build the team around the survivor? then advocates could join the team. nobody would make the survivor prove, as their judge and jury at every step of his or her

journey, they wouldn't have to prove their case over and over again. there would be a team that believed them. inspectors and responding officers would believe them and would start with all of us to build a team. to build that support around the survivor so then when it got time to present a case, everybody would be engaged in it already. there would be advocates, people would know how to talk to survivors and they would form a team very early on. we could do this. we already work together on so many other issues, that i think we could, i know this sounds pollyanna but it could easily be done. we could form a team from the second the survivor reached out. in fact, we could form a team to help prevent it. but we could form a team from the second the survivor reached out and just continue that team work until the survivor got

whatever he or she, and the justice system, or the civil system could deliver for them. we could form a team. we all know each other. so i'm really looking forward to working with all of you and i just want to thank all the brave survivors that came forward today. there are thousands more. thank you. >> supervisor h. ronen: thank you. next speaker. and if anybody else wants to speak, if you could please line up on the wall so we could see how many people are left, that would be helpful, thank you. >> hi, my name is leah gerard. i didn't plan on speaking when i came in today but i felt compelled by the beautiful testimonies i heard today, because i'm one of the lucky one and two that hasn't experienced sexual violence in my lifetime. but the amount of my personal friends, my family members, of my roommates, of my college students, the demographic i'm a part of is at the greatest risk, probably, out of everybody in society.

and these people would rather live with the guilt, the shame, the emotional duress, the p.t.s.d. that comes with being discriminated against and that comes with sexual violence than admit to themselves, admit to other people, admit to an institution that doesn't support them from beginning to end that they have been harmed. and i don't feel like any other physical or emotional violence is treated this way. if someone broke into your house, no one will ask you to prove it, or test the d.n.a. on the broken glass, if someone held you at gun point, no one will ask you to prove it, or interrogate you the same way if you said someone has come and committed a crime against me. this is an intersectional issue. it's an institutionalized disproportionate issue and problematic the way my school deals with it, the way the city deals with it.

the way i didn't feel welcome walking into this building necessarily represents the disparity between people who are supported by laws and by criminal justice in the city and in this country and in this world. and i think that starting with breaking down a taboo around sexual violence and speaking about it and not only having support groups that are recreational and extra curricular but actually having ones incorporated with the city and state and are mandated and train the people that work for these institutions is the place to start. so thank you very much for your time. >> supervisor h. ronen: thank you so much. >> good morning. thank you for holding this hearing today and special thanks to supervisor ronen, carolina and your office for your support and your call for reform.

and thanks to everyone who spoke out today. i will introduce myself as jane doe, though some recognize me as a long time employee of the city's human rights commission. in fact last time i stood before the board of supervisors was about two and a half years ago when i was honored for my work at the h.r.c. just days later, i was drugged and raped. i grew up in new york in a big close-knit family, for college i move today d.c. where i studied human rights and began a career focused on civil rights, i've been with the s.f. h.r.c. since 2010. citizens come to me with complaints of discrimination. we investigate them, we mediate them and a resolution is reached. i intimately know how our city department function. what's happening to victims of

drug facilitated rape in san francisco is a failure of the system. those who summon the courage to report this are punished for having the audacity to believe if they go to the police the police will take the investigation of their rapes as seriously as other serious crimes. january 2nd 2016 was a saturday. i went out to catch up with a girlfriend that night. and shortly after midnight i met a charming man who went onto trick, drug and rape me. within hours i reported the rape to police. i threw up in the ambulance on the way to sf general. there i was brought to a dingy waiting room where i sat for hours waiting to be seen. i was physically ill and in shock. no one told me what to expect or offered assistance or orientation. there was no phone service so i couldn't even call my family. i later learned i was waiting

in line by other rape victims by a nurse who could conduct the rape kit examination. an examination of the entire body that collects d.n.a. and other evidence of the rape. the nurse was lovely and professional but she was the first person to take my blood and urine. in a drug facilitated rape, they use drugs designed to be eliminated rapidly from the person's body. police and e.m.t.'s didn't take my urine nor save my vomit as evidence. letting critical hours pass before taking evidence is equivalent to destroying evidence, that wasn't immediately preserved toxicology tests were unable to detect the drug used to incapacitate me. the day after i was raped i went to the special victims unit and met with an svu sergeant, i told him i wanted the predator who raped me to be

arrested and prosecuted, unlike many drugged and raped i remember being raped. i briefly came into consciousness while he was raping me but i was unable to will my body to scream or to move. i also knew the rapers identity and had a third party witness to key facts that i was unconscious before i was raped. despite these critical facts the sergeant greeted me with discouragement from the moment we met, making comments like these things are so hard to prove. it's complicated, he told me and suggested repeatedly i merely combined alcohol with my prescription medication, but didn't ask if i had taken any medication that day, which i had did not and asked if i really want this guy arrested. i was intimidated and rattled by his discouragement but i have not wavered in my resolve,

it was like the twilight zone, since that first meeting the s.v.u. sergeant revealed not only his incompetence to handle the rape investigation but plainly doesn't regard rape a crime worth his while to investigate. his missteps during the investigation were shocking. i will give you a few examples. despite asking him over and over to please secure the videotapes from the bar i was drugged, he failed to do that and the bar taped over them. he failed to seek key witness statements and told me there's no way to get toxicology results for six months and no way to get them expedited, this suggests there's no sense of urgency by the s.v.u. to process key evidence nor did the sergeant have the inclination to even try. i since learned it is possible to have toxicology tests expedited. perhaps most egregious, the police treated me as though i made all this up.

months after i reported the rape the sergeant began a sentence by saying, if you did in fact have intercourse with him... i had to remind him i did not have intercourse with the rapist. he had intercourse with my unconscious body. moreover the sergeant suggested there is an if in this case is nauseating and degrading. i promptly and consistently reported to him i remembered being raped. there's no "ifs" in this case. i can't imagine another crime where it's suggested to the victim she is making it up, nor imagine another crime where the public safety threat is taken less seriously. based on the rapist's brazen conduct the night of the crime i firmly believe i'm not the first or last woman to be assaulted by this predator. when i pointed out as long as the rapist is free he may be raping other women the sergeant

flippantly responded well hopefully they will come forward if he does. if there was a known knife wielding attacker on the loose i'm sure the response wouldn't be hopefully all the stabbing victims will come forward after they are stabbed. the attacker would be arrested. this isn't treated as a public safety issue by the sfpd. these failures can't be chalked up the to incompetence or misogyny of a rogue officer. i report today lieutenant edward santos and chief gregory sur. no one intervened. this is a predicament which no victim should be left at the mercy of the investigating authorities not doing their jobs but any pleas to them to investigate or take the case seriously jeopardize whether the criminal case will go forward at all. it is profoundly sad and unsettling to have been dehumanized first by the predator who raped me and then by the police.

the organization i went to for protection and justice. each time i interacted with the sfpd, sorry, oh my gosh. i spent the night crying, stunned and sleepless. i have nightmares not only about being raped but also about having to fight for my case to move forward at the police station. such betrayal of trust. sfpd needs reform, their institutional failings are based on bias and collective interest in protecting their own fellow officers. it acts as a gate keeper to justice but where do we turn when the gate keeper is complicity in crime? this is not hyperbole, sfpd makes a mockery of rape victims. unworthy of time and effort.

this must embolden predators and cuts in the moral and psychological fabric of our communities. it's easy to understand why so many victims fail to subject themselves to this. there are moments i wonder if i shouldn't have reported this, if my p.t.s.d. wouldn't have been so severe if i didn't spend the last two years and four months of my life asking for this criminal to be brought to justice but i can't accept the alternative. it's unconscionable. we need change. it's appalling to think how my experience of being trivialized and mistreated. i have in my support network extraordinary advocate jane manning. at city's human rights commission i work with some of the most vulnerable individuals in the city, many of whom face barriers to accessing resources

and support. it's chilling to think of the members of this community attempting to navigate sfpd special victims unit. [reading] i've done my best to advocate for myself and others while trying not to alienate those in law enforcement responsible for the fate of my case. imagine this happened to you. what would you do? i wrote to the head of the sexual assault response team, dr. botchelari about my experience and how cracks in the system could be filled. she graciously met with me and discussed each of my concerns. when captain bali became head of the special victims unit i wrote to her as well and the head of the civil rights commission. i wrote to supervisor campos.

he and now supervisor hillary ronen have been supportive through this nightmare. supervisor breed i wrote to as well, she is my district representative. i asked her for help. it was disappointing to simply be referred to a non-profit in response. i have met with advocates in non-profits, beverly upton whose words i couldn't agree with more. i appreciate the support i have received. and i've been told by prosecutors, from the san francisco district attorney's office that i did everything right and they believed me. although there's an abundance of evidence in my case, 842 days have passed and still no arrest has been made. sfpd is showing jarring incompetence, misogyny and callous disregard to rape

victims in a way that shows gender bias, this continues to be damaging to me as a victim and there's little victim advocacy here in san francisco. nobody is following up with every single victim that goes to sf general and to the police and also advocating for appropriate steps to be taken by law enforcement in each of their cases. the first night after the rape, after spending the day at the police station, my sister and i had dinner together. i told her this wasn't going to change me. i couldn't have been more wrong. i never could have fathomed the catastrophic impact this would have on my life. being disregarded by law enforcement is an ongoing trauma and an absolute impediment to recovery. at first i could not relax or sleep or think. my body was tense all the time. when i did fall asleep, i would

wake up convulsing with nightmares. flashbacks of the rape. i could think of nothing but the rape and each day was a battle with incompetent misogynist police. i became like a totally different person. i had been in a good place personally and professionally. suddenly, i couldn't work or even talk about anything but the rape. my mind and body were gripped. i cried all the time. i would forget to breathe. i developed severe p.t.s.d. i did everything i could to try to escape and get back to normal to feel like myself. thanks to insomnia and hyper vigilance i would get up before dawn and go running but i was frozen in a nightmare the rest of the time. i couldn't believe i had been

raped and the police didn't care. i would go to work but i couldn't read and couldn't concentrate. eventually i took a leave of absence when i was fortunate enough to connect with the trauma recovery center, rape treatment center. the trauma center has been so incredible and my treatment is ongoing but the trauma of being discarded by law enforcement makes recovery elusive, it's demoralizing and maddening. everyday i struggle with severe depression and anxiety. i shake. i have tremors all the time. even as i stand before you now, i have panic attacks. i jump out of my skin at the slightest noise or surprise. i have to sit with my back to the wall in public spaces. and i'm a shadow of the person i used to be. this is all consuming.

focus on healing law enforcement tells me over and over when i ask what progress has been made on my case. this refrain is a cruel joke. i've tried everything, therapy, yoga, meditation, bottling it up, you name it. i will continue to scratch my way out of this darkness but what i really want is a life not spent thinking about what can be done, what should be done. since the time i reported being raped our society has become a seismic shift. more and more women are summoning the bravery to say #metoo publicly, the sfpd must rise to the challenge and fulfill their duty to serve and protect. we need reform. and i implore you to be the force that makes traumatizing experiences with the sfpd like mine a relic of history for women and girls in san francisco.

thank you. >> supervisor h. ronen: thank you so much. is there any other member of the public who would like to speak? seeing none, public comment is closed. i want to just start out by thanking everyone who came forward and told their stories. this is one of the hardest topics and experiences that someone has to go through. most people never report these crimes. and to not only have the courage to report those crimes, be treated in the way they were treated but then come forward and publicly tell those stories is extraordinary and i just want to express my gratitude to all of you. i know that my colleague supervisor stefani might have to leave soon so before we turn

it over to city department ask if you have any comments before you have to leave, or questions? >> i don't have any questions at this time. i just wanted to thank everybody for coming out and for being brave enough to tell us your stories. by doing so, you empower other women to feel like they are going to be okay and empower other women and men who have been victimized to get maybe the help they need. i also want to say to one of the women who, i think she said she was 19 and drinking at the time and she was an alcoholic, sounds like she is in recovery. congratulations, you are a miracle. alcoholism is a disease. the stigma and drug addiction -- the stigma around it in our society is absolutely disgusting. there is never an excuse for rape.

especially if you are drinking, i don't care if you have one glass of wine or 20, there is no excuse and no one should ever feel bad because they took a drink and were victimized and i want to make that clear. i also want to say i do have a lot of hope that we are going to make a difference on this issue and i thank supervisor ronen for bringing this to our attention and jane manning for her comments. and the reason why i say i have hope is because i have worked for now for 11 years with so many different police officers and formerly as a prosecutor. and i know, and i have relationships with a lot of police officers in the s.f.p.d. and they are my friends. and i know these police officers, the ones that i know, not the ones that have been mentioned today, i don't know them, i don't know those names, but i know they care and i know when i go to the leadership of

the s.f. police department and the people i will speak to, i know they care. and i know they will work with us to try to make a difference. i know that, because i know these people and i have worked with them. so i just want to tell you that i have hope. and i'm committed to working on this issue. and again, i want to thank all the women and men who came out to testify. your stories, you are brave and you will make a difference and again supervisor ronen, thank you so much for bringing this to my attention. i'm sorry, i'm going to have to leave to my next event. thank you. >> supervisor h. ronen: thank you. now i would like to call city departments in the order most victims interact with them. first i would like to call forward, if there are representatives here from san francisco general hospital. thank you.

>> good morning. my name is katherine klaassen and i'm the director of the division of trauma recovery services at san francisco general hospital. >> supervisor h. ronen: sorry, your name? >> katherine klaassen. first i want to acknowledge and thank all of the brave

survivors who have testified today. their voices, your voices are important for all of us to hear. it may sound odd to say this but it's a pleasure to be here during sexual assault awareness month and on denim day, he want to say happy denim day, which may sound strange to any sexual assault survivor and those wearing denim in solidarity to them, and all here today in solidarity with survivors. thank you supervisor ronen for calling a hearing on this important topic and thank you, supervisors for being here. i would also like to acknowledge and express appreciation to several of my staff in attendance today and to our partners for their dedicated work. finally i would like to acknowledge cathy blue the nursing director of our department and who will be assisting me in answering any questions. let me provide a brief overview

of our sexual assault services. our mission, we have respectful care after sexual assault, provide before and after care and collect forensic evidence. our services include medical examination and treatment. h.i.v. pregnancy and prophylaxis. we collect forensic evidence and conduct an interview if indicated. we also provide trauma focused mental health treatment in case management and links to care and other legal and support services. i don't know if you could read this. this is our pathway to services. this is what happens when a

survivor comes to the emergency department at the hospital. first thing that happens they get registered and they are triaged by the e.d.r.n. they are assigned a room. then toxicology will be collected. they will call out for sexual assault provider to come and provide services. the survivor will meet with the provider and during office hours, we will also have a mental health provider come from the trauma recovery center to support the client. the next thing that happens is that the survivor is given informed concept. so they are told about what rights they have. to get a sense of whether or not they want to get the police involved. to give them an idea of what's going to happen and to prepare them for the next steps.

if they decide they want to have a rape kit, those services will be provided and then we will discharge them to either a home or some safe location. and then they are invited, we give an appointment for a follow-up appointment for them to have medical follow-up and also for them to receive some mental health services. i should mention that when they are being seen during the day and we have our mental health support there, we do have mental health assessment. they have a follow-up appointment, they come to the trauma recovery center. and at that point we are going to connect them to advocacy, psycho therapy services and case management if they desire it. i've been asked to say a little

about our feedback process. survivors will be given a document on consumer grievance and complaint procedure. everyone will get that. we also, within our division have developed a policy and procedure related to feedback. so we take our feedback very seriously and address the complaints as promptly as we can. we do an investigation, talk to whoever we need to talk to, reach out to the survivor, do what we need to do in response. we have also recently we gave a survey to get a sense how survivors were, what their experience was from us and the team, so that's informative. and based on the feedback we have received and also our own sense of the quality of the services that we provide, i

just want to say that, mention that, our providers are such a dedicated team and they are so attuned. we have instituted changes so we could ensure that we take blood and urine samples within 30 minutes of people's arrival at the hospital. in addition, this is an area i think our providers are especially sensitive, we want to make sure that survivors are waiting, sitting, in a location, if they do have to wait, where there is as much serenity as we can, we are in a very busy e.d. department but we have now moved our room

where it's much quieter. >> supervisor h. ronen: when did that happen? >> this has been a work in progress. i would say that particular piece, we were in discussions for probably eight months figuring out where to put that space and i would say it's probably the last three months that we have been in this new area. >> supervisor h. ronen: is there cell phone reception there now? >> that's a good question. >> [off mic] >> supervisor j. sheehy: please come to the microphone. >> hi, i'm cathy blew, katherine's partner in this. yes, there is cell reception. the e.d. is in the newest part of the hospital where wireless and cell reception is good. >> supervisor h. ronen: okay, fantastic. >> finally, i want to give a little summary as to the work we have been doing over many years.

since 2001 we have seen 5,634 sexual assault survivors. we have served that many, in 2016-2017 we served 401 survivors but what's important for us is this is a 21% increase over last year. so we are seeing more and more survivors. and i don't know what that means. the #metoo movement may have something to do with that. but certainly, we have a lot more work to do, for sure. three quarters of the people that we see are women. a third are men. and as you can see from this next bullet point, that it's a very diverse population that we serve. in the last year 200 received mental health services and this too, is an increase of 16% over

last year. we collect data systematically. one of the things we can do is to try to show whether or not, keep track of the people we are seeing and also whether or not we are helping them in the services we provide. and our data is showing individuals who do receive treatment from the trauma recovery center are showing a significant decrease in anxiety and depression and increase in quality of life. i will stop there. >> supervisor h. ronen: thank you. we are going to lose supervisor fewer in a few moments. great to hear about the new waiting room and cell phone service. i had heard that time and time again the old space being isolating and difficult. thank you for that. and thank you for taking the blood and urine samples quickly now, instead of hours where

possibly drugs could leave the system. so, having heard, i just want you to take back that feedback of having heard that one story of a survivor who never reported a rape or sexual assault right after it happened but had mention it had to her doctor and was told that happens to all women. that's very troubling and if you could bring that feedback back, and make sure there's additional training that happens. we don't need to talk about it because i'm sure -- maybe that's unusual, maybe it's not. we should find that out and be continuing to work on it, i just want to highlight that testimony for you. >> thank you. >> the other thing i heard you chaired interdepartmental meeting every month to look at better collaboration within the department? >> that's the s.a.r.t. meeting, yep. >> supervisor h. ronen: are there any sexual assault survivors who come in and meet with you? >> you know, there are not.

i know where you are going with that. i think that would be useful to have that, a voice of a survivor in that meeting. >> supervisor h. ronen: great, i just wanted to get that clear. now also, we hear that sexual assault increases on particular holidays, valentine's day, christmas, new year's. do you increase staff when you track whether or not there's increases? so that survivors don't have to wait? >> we do our best -- staffing is, i have to say, a real challenge for us. and it's true over the holidays there will be an increase, but it could also happen randomly. yesterday we had four sexual assault survivors show up. so it's kind of an ongoing problem. i wonder if my -- can you speak to that, cathy?

>> when we look at our scheduling process, you know, you are right, there are specific times when it's more predictable. and there are the random times like yesterday when four survivors show up simultaneously. and what we do in those cases is one, assure that people are medically safe. that's the value of being in the e.d. so getting people checked in the e.d., getting them into a room, making sure all their medical needs are met while we try to rally resources, bring more people in, which is what happened yesterday. we had capacity because we have leadership. >> supervisor h. ronen: so when you know these times you don't staff up? sorry, last question, we are running out of time, appreciate that you are here and continuing this conversation.

but given that you are often the first person to interact with survivors after the most traumatic experience of their life, do you -- the intake procedure, is there any sort of orientation that happens? this is what's going to happen? this is what will happen if you feel comfortable at different stages? any idea of walking someone through so they know what to expect? >> absolutely. absolutely. that's the first thing that will happen, we really prepare women for what is about to happen and what the follow-up might be for them. >> supervisor h. ronen: through each stage, with law enforcement? >> that piece? do i have staff here that could speak to that? sara? >> sure. >> this is dr. sarah mets, clinical psychologist in our program.

>> i could speak to it, probably not as specifically as a medical provider that is in the room but part of what they do, the first interface is actually e.d. triage, but once they come into contact with one of our medical providers, we have to get consent first and foremost, we have to ensure medical and psychiatric stability for consent, so if that's not stable we can't move forward with the forensic exam. but once we determine they are able to consent to services we talk about their options. we are able to speak with them about here is what will happen if you want police to come. we give them their options, you could get a kit, no police, we will still treat you, it's free, we give them handouts and let them know about their medical follow-up that occurs at the trauma recovery center. we educate them as much as possible as far as what's going to happen in that very moment. once they come into the trauma

recovery center, the acute medical component is generally over but we also, we will do our best if they want a prosecutor, making police reports we walk them through as much of the process they are either interested in learning about or they are engaged in. >> this is again something that i would love to have more detailed discussion about in the future. but i think as beverly upton so eloquently and poignantly testified, if from the get-go, there was a team wrapped around someone at their most critical moment that makes them feel comfortable continuing with the process, we know that rape is abysmally under-reported and having heard from other survivors in the community, you are safe from the get go, people believe you. the opposite of what people are

hearing now could make such a difference. >> i would love to have a conversation with you. just to say the services we offer at the trauma recovery center, that half of the women took up, that's exactly what we do, we really walk them through all that. yes. we all need more, don't we? >> i think my colleagues might have some additional questions. >> yes, thank you very much, supervisor ronen. i wanted to just touch on the pathway to services. when you said during business hours, monday through friday, mental health provider is available for adult clients to provide support and advocacy. i was just wondering if you have any, this isn't convenient for people. i'm just going to say. you have to take time off from work, this is an emotional experience. to be able to do this and go back to work and function at a capacity in work is not realistic.

for those of us who have had therapy we know it's draining. it's draining before you go, it's draining after you participate. i'm wondering, do you have any plans to expand this to weekend or after hours? i wanted to know do you provide any kind of child carat all? -- care at all? because just during business hours monday through friday is actually, i don't think as accommodating as probably we would need to be. and correct me if i'm wrong. i'm just assuming. >> i couldn't agree with you more. what's happening here is that monday to friday when we have the trauma recovery center over, we have staff available who could meet with a sexual assault survivor when they are first going to the hospital, that service. but only those people who show up between 9-5, monday to friday are going to get that. so there are all those hours when they don't have access to mental health and it would be

wonderful if we could somehow find a way to give them access. >> how much would that cost? >> could i get back to you on that? >> yes, to expand that, to weekend hours. we have heard today testimony that is actually very, very compelling that women need emotional support around this. and it's something actually that is very difficult to handle on your own and you need outside help, actually, to be able to function in regular daily life. especially those who are parents, those who have jobs, even for any individual. i think that's kind of imperative, quite frankly. i also want to ask you about this program summary, you said 5,634 sexual assault survivors served, so in a 16-year period of time, population of about 800,000 people now, you have served 5,634. what percentage do you think

that is of the actual sexual assaults that might happen? or do you have any idea? >> oh gosh, that's a really tough question. i would hate to hazard to guess on that. i'm sure it's a fraction. but i really, you know, we could look in the literature to see, but i don't know. if they don't tell us, we can't count them. >> i guess i want to ask you in your feedback process also, do they give any reasons why, if they were apprehensive about actually reporting this or coming forward? are you gathering any of that type of information at all from just survivors themselves about putting sort of what their thoughts are and if they initially thought they would not come forward but did. like what were those deciding factors actually? do you take any kind of data analysis, or collect any kind of data around this?

>> we aren't collecting that type of data. we would have to develop some sort of measure to do that. the best we could do is to go through our charts to see what happens when people come for treatment and what do they talk about. and there we might be able to extract some of that data but we aren't systematically trying to collect that data. >> i'm just wondering how we could do it better. how we could reach more vekt ims. -- victims. how more victims could get help. how to reduce the stereotype of shame and one of them, i think, is how our victims are treated. but also how we could just be more transparent, more helpful. i think also much more supportive during this process when people have been severely traumatized. anyway, if you could get back to me, if you have discussed at all about expanding these

office hours, the mental health hours that people could come and get some help and also if you have thought about extending it to weekends and if you offer any sort of child care at all. >> i will get back to you on that, is that okay? >> and i have to ask, are you doing this in different languages and which languages are you providing? >> yes, thank you. i should have had a slide on that, we have spanish speaking provider and cantonese and we have access to interpreters, i think portuguese, we cover the languages fairly well, we find a way to do it. if we don't have it in-house, we bring in an interpreter. >> when you and your providers are speaking in non-english, in another language, are they also culturally sensitive around the culture around sex and sexual

assault? >> sure. at the trauma recovery center, we are so cognizant of that issue of cultural awareness. we actually, on a regular basis, we spend time talking about cultural humility. we have a very high bar around that issue and we are constantly learning. >> so i just wanted to say, i'm so sorry i have to leave this meeting early. but i want to say, do you think that your department would be a department that would actually be a good place to start with a citywide training of providers after a woman reports a sexual assault? >> to train other groups? >> i think today we heard about a need for citywide training. i'm wondering if you feel your

department is a place to start? >> i think we are in a good position to do that. we already do a fair bit of training. so it would be a reasonable place to start, for sure. >> okay, thank you very much. >> [off mic] >> i'm so sorry, apologies. never done this before. >> you are doing great. i'm just trying to understand what the experience is when someone walks into the e.d. there's not a mental health professional there when someone presents? >> there's not someone there. the rape treatment provider isn't there either. so they need to be called. they are going in, in an e.d. department and they kind of register like everyone else and then we start to mobilize our resources for them. >> unless they present during the day, they don't see --

>> they don't get mental health, no. i mean, they don't get it when they are there. want to say something about s.f. -- >> i want to highlight that there's not nothing on evenings or weekends, we can call. they aren't mental-health trained but they are trained to support acute sexual assault survivors. >> so you have an advocate on call? >> correct. >> i mean, have you really worked with the -- the sexual assault community to really determine best practices? because i know your department has a trauma informed care priority. this doesn't really seem to

feel to me like a trauma-informed model. and i've seen other parts of both department of public health and u.c.s.f. where people have implemented fairly robust trauma-informed care models. at this point where people are coming in to pretty extremely stressful traumatizing situation. i'm just wondering what could be done to improve that first point? it seems fairly isolating and not in a mental health setting. >> if i could speak for a moment, it is true that being put in a room in e.d. could be isolating. but we work in partnership with the e.d., we meet with the e.d. nursing leadership on a regular basis.

the e.d. nurses get training on how to talk -- please stand >> that is okay, i mean -- >> i wish we did.

>> for routine mental health needs there is the psychiatric emergency which is right on the campus. the psychiatric team is the last place that they would want to go. it's a traumatizing place. >> there is capacity to ensure that someone if you present at 3:00 a.m. and have urgent mental health needs you will be seen by a provider. >> okay. >> seems like afte after assault is an urgent mental health need. >> i agree. if we could have services to pre