>> thank you for taking your part on this very serious issue. in looking at the progress in the very corrective actions that have been completed, is there a timeline for the remaining ones that was set by the state or otherwise for completing those, as well? >> there aren't necessarily time frames other than what we put in place, but we are dividing those remaining items into both short-term, intermediate, and long term. for example, a short-term would be to solidify the job description for the new laguna honda c.e.o. we have been working with the department of human resources to actually do a recruitment process. more long-term things are the r.f.p. listed in the plan where

we will actually put out a request for proposal for an expert to actually come in, do an assessment of laguna and help inform in terms of its current state, and perhaps where it needs to go in terms of being a world-class, long-term care and rehab facility. in focusing on both short and intermediate and long-term, and we actually internally have documents that break out what those things are. they are just not in what you received today. >> thank you. >> yes, thank you for your report and thank you for the draft. it was a very good summary of the findings, and the work that you have thus far done. >> that credit goes to the quality team for putting that summary together. you could see it is in a format that you are familiar with. >> i think it shows that you

have summed up the issues that we are all facing. i do think that the draft needs more of a timeline, and i think that the issue that we have before us is just as important as when we were building the building, where we followed carefully what the corrective action, in that case, the buildings, and how well we followed it. i would suggest then that one of the reporting criteria should be not just in quarterly to the board of supervisors, but that it comes to the health commission. certainly the j.c.c., on a monthly basis, appropriate he follows your everyday progress, and that in order to do that, it really requires that there be a more explicit timeline for each

of the items that you are talking about, because clearly then we wouldn't be able to follow if we didn't have a timeline to see if we are going to be on target and that the timeline needs to consider not only the regulatory part, but the part in which we are able to take the opportunity to work with our staff and the in the thousand plus employees that we have almost all of who have done a good job, and this is an issue of which a few have blemish the work that so many of us have done in such a fine institution for all of these years. i think in addition to trauma informed, this is a good opportunity to look at our application of cultural humility at the hospital, you know, there have been a lot of discussions about how we are actually

looking at culture. i think it is not near -- merely a culture of reporting, but one of truly cultural humility and that may be one of the course of the problems that we saw in the small opportunities of our ability to understand what is happening there. i would ask that as we move forward, that this is a good start, but that we need some timelines, we need some regular reporting done so that we are sure that we are on target, that if there are needs that we all become aware of it and we worked together with this city to ensure that we are able to respond. we may find some things that we really need some greater

opportunity to actually take advantage of. although you spoke of the proposal for partnering with consultants, that that be actually something potentially a lot sooner than the long-range plan because just merely catching back together where we were is probably not the answer, and perhaps one of the ways we want to do it, and it is up to the administration, is to also get expertise from other experiences that allow us to then put in place the right measures that we need in order to understand that our facility is performing and is giving our san franciscan his the best, best, as you say. >> thank you for those

suggestions and recommendations. we will definitely take those to heart. we will go back and look at the rebuild timeline. i know we worked to really refine that for a way the commission could see progress and look to see how we can adapt that to this reform plan. i think there was a chart that really shows what we do and where we are in terms of being on track. is that what you had in mind? >> something like that. where we actually are able to understand at what levels you are. you have obviously got one already in which there are regulatory things that have to be done within a certain period of time. with some of the others including doing your hiring where you are with their community programs and so forth. if we know where you are going, we will know what to hold you accountable for. >> in terms of the r.f.p., i

probably misspoke when i said it was more long-term. it is actually in the short-term the in the developed of the r.f.p., is knowing how long it takes a put it on the street from this proposal, reviewing the proposal, and awarding the contract. it will be a little while before that happens, but we are beginning on working developing the r.f.p. right now. >> sure. i really do think that that could be really helpful to the department if there is a way to even expedite that and get that so that you all have that expertise and advice that you can all work together. i think that will make more corrective action for us. >> agreed. [indiscernible] have there been any activities to promote -- [indiscernible] especially with the patients? >> yes.

if i miss anything, i will ask the acting c.e.o. to help fill in, but there have been all of that care teams and all of the neighborhoods at laguna have actually had dedicated time working with patients on those units and some of the surrogate decision-making to really talk about what happened. we have also had resources from city health services to come in and work with staff both in group settings and individual sessions who are having difficulties as a result of this entire experience, and we have an open-ended commitment to supply that type of support for as long as we need it. >> thank you. >> i want to add my voice to my colleagues on the commission to indicate that what has been described in the report regarding that behavior is not reflective of the institution

with its history and staff who have been dedicated to san franciscans and our most vulnerable populations. we need to recognize that is very true, as well as the support for line staff and patients, i have said it before, the administrative staff, the executive team, they need that support because they were traumatized just like everybody else who was acknowledged that this has occurred. i want to make sure that there are people in the honda family who get access to that very important support, and i encourage -- and are encouraged to take it. it is not an order, but you should be encouraged to take some leave to address the issues that have emerged as a result of this. and some of it will be later on. it will be ptsd, kind of, so we need to be on board and aware that that is possible. thank you for your very thorough report.

>> next item. >> thank you. item h. as other business. you have the calendar in front of you. i don't have it in front of me so i can't remind you of things. there are two meetings that are coming up with the planning commission, one is october, and again i don't have the date in front of me. it is a thursday. you will all be discussing -- yes, thank you, in december 12 th is another day that you will be looking at the healthcare healthcare service master plan. those are the two unusual dates coming up. >> there are two items. one would be the request that we do what we can to respond to the family of brandon lee so that i don't, i don't know what the department is doing, but doing what you can to see if there is any support that can be provided to bring him and if it is

possible to authorize a statement of support on behalf of the san francisco resident and his family, who has dedicated themselves to san francisco. the second would be with regard to the cease and desist order to the massage therapists, i'm just wondering if there is administrative relief that we can do, even though there is an ordinance that is in the hands of the board of supervisors. the department here has a role in providing some directionality , particularly given the testimony here, and i guess they report back to us in terms of what can be provided. >> thank you.

>> thank you, commissioners. item nine is reported back from the august 27th, 2019 meeting. i'm bringing you my last announcement that you can read off of. >> thank you. [indiscernible] >> could you craft up the document about the -- [indiscernible] >> yes, thank you. i will remind you what happened in this. this is just august 27th, i should remember. we didn't did discuss the regulatory c.e.o. report and the human resources report and we also heard an update on the expensive and very successful go live implementation. the enthusiasm that people had

around it, i may note it is one of the first times i have seen an d.h.r. rollout in a hospital where people weren't enthused. during the medical staff report, the committee approved the following, a new psychiatric department chief, and standard procedures for genetic counsellors. r.n. medicine refill, ob/gyn in pediatric village list, and it was in closed session where we then discussed the reports. >> thank you. any questions from commissioners the next item, please. >> i believe there was something brief to say. >> dr. colfax? >> i just wanted to also acknowledge the commission

because of the leadership role that -- dr. alice chen, who knows the chief medical officer of the department. we weren't able to share this in writing for various reasons, but she is moving on from the department to be deputy director of health policy and chief medical officer at state and it is an amazing opportunity for her, at a huge honor for us to have her go work at the state level. i just want to acknowledge dr. chen's leadership and her many contributions to the health department. she has mentored many people in the department, and we will miss her very much, would just to really congratulate her. if i may be so bold, absolutely if the commission would be willing to determine her on her. thank you. >> we would do that and say yes to this secretary that we create a document that honours her as she leaves the department. i would foot -- i will forward

you the e-mail where the full title of her new position is explained. >> the next item is consideration for closed session >> i would like to move for a closed session. >> second. >> all those in favor signified by saying aye. >> aye. >> thank you, everyone who is not involved in the closed session. have a lov >> move to go back into open session. >> second. >> all in favor? >> i -- aye. >> motion to disclose or not disclose? >> second. >> all those in favor? >> aye. >> motion to adjourn in honor of alice chen. >> motion to adjourn in honor of alice chen's service to the department of public health and the city of san francisco. >> second. >> all those in favor say aye.

>> aye. >> thank you. >> we are adjourned. >> okay. we are here to get the job done. good morning. is it morning still? i've been up since 5:00 i think. i'm trying to keep -- i've been

to so many places throughout the day. this is probably the fifth or sixth, but who's counting? thank you all so much for joining us here today. with me i have dr. grant colfax, who is the director of the department of public health, as well as dr. anton nagusablan who is the director of mental health reform. daniel leary, the c.e.o. and founder of tipping point community, and matthew state, the chair of u.c.f. department of psychiatry here in san francisco. i'm excited because these are incredible leaders in our community who are going to help us with some really challenging problems that we know we face as a city. last week we launched the mental health reform initiative to help those at the intersection of homeless, mental illness, and substance abuse disorder in san francisco. and through our detailed

analyst, dr. nagusablan and the department of public health have identified the people in our city who are most vulnerable and in need of help. now, to be clear, we see it. but now we have clear and accurate data. of those 4,000 individuals, 41% frequently use urgent and emergency psychiatric services. 95% of those folks suffer from alcohol use disorder. 35% are african-americans, despite the fact that we have a less than 6% population of african-americans in san francisco overall. so we have a lot of work to do ahead of us to provide the behavioural healthcare that people need. we need partners to do it. we need to work with our state officials, with our philanthropic organizations and our non-profit communities.

that's why today i'm excited to announce that the city has partnered with tipping point community and ucsf who share our goals of addressing the mental health crisis in our city and providing people with the care that they need. we know that addressing the needs of the most vulnerable requires experts in the field, it requires collaboration and the development of public-private partners. tipping point and ucsf department of psychiatry came together to really understand how to improve the outcomes for san francisco residents experiencing long-term homeless, but who also have challenges with behavioural health. they worked with the city departments and various community-based organizations who helped to put together information to inform this comprehensive report, including the department of public health,

the department of homeless and supportive services, the hospital council, p.r.c. thank you, brent andrews for being here and your amazing work. health right 360. thank you for your rigorous work on what we deal with in terms of treatment for folks who also sadly deal with substance use disorder as well. thanks to the rigorous research conducted by tipping point and ucsf. we have a report that we can use to implement data-driven policy decisions that will effectively work and change our city for the better. this report highlights how philanthropic and public funding can work hand in hand to help san franciscans suffering. they have provided several recommendations to improve our system coordination, because we know that it definitely has a few holes in it and it needs to

be better coordinated. enhancing people's access to treatment. meeting people where we are. we can't think they're going to show up at the door of a location for help or for support. we are going to need to go out there in the streets and meet people where they are. engaging more people in care and services. we are excited to partner with them to implement these recommendations. but also in order to address the mental health crisis in our city. we need to build on what is already working. we're going to do that in part by expanding the number of hummingbird beds in a city, in our city. today i'm really pleased to announce that thanks to the funding from tipping point, we'll be able to add 15 new hummingbird beds which offer psychiatric respite.

that is absolutely amazing and it's really expensive. [ applause ]. >> mayor breed: so with these new beds, we'll be able to connect people experiencing homelessness with behavioural health needs, the care that they need. i'm not sure if any of you have visited the hummingbird facility at s.f. general, but it is absolutely amazing. i had an opportunity to not only touch bases with clients, but we also did an announcement last year expanding the number of beds at that location as well. to hear someone say to me that i'm trying, it's hard, but i'm glad to have help, it makes all the difference in the world. this is an incredible facility and i'm so proud of the work that they do. as dr. nagusablan will get into

more details, we know that the vast majority of the 4,000 people we have identified unfortunately have alcohol use disorder. the tipping point report includes some innovative suggestions for treating those suffering from alcohol use disorder and we are looking forward to making some changes and implementing some of these in the coming months. there will be more could you tell mes to come and dr. nagusablan will continue to implement our approach to healthcare because that's his job. we will recommend more ways to improve care for our city's most vulnerable residents. we all, as i said, need to work together to address this challenge that we face. with policy, financial investments, and working in a collaborative approach. so we truly appreciate the

partnership of ucsf and tipping point. now, i want to turn this over to the c.e.o. of tipping point community. they've done a lot of work to address homelessness and taking it a step further by digging into the root causes of some of the challenges we face to make the right kinds of investments. this is going to make a world of difference. ladies and gentlemen, daniel leary. [ applause ]]. >> thank you, mayor breed for your leadership. we know that the primary cause of homelessness is a lack of affordable housing, but we also know that behavioural health conditions, like mental illness and substance use disorders contribute to homelessness.

without a stable home, these conditions are far harder to treat. in partnership with ucsf's department of psychiatry, tipping point engaged a public health consultancy called john snow inc. to improve opportunities for san francisco's existing behavioural system. we convened leaders from city departments, from ucsf, from s.f. general hospital, and a variety of community-based service providers. we conducted dozens of stakeholder interviews, including a focus group at the respite center. we engaged closely with the department of public health throughout the process, checking assumptions and findings against the experience of our city partners. now, as the mayor said, the findings are in. we need to know the names and needs of everyone who is

homeless with a behavioural healthcare need, provide wrap-around services that promote stabilization and a path to permanent housing, and ensure that systems and services proactively address and reduce disparities, especially among black and lgbtq individuals experiencing homelessness. tipping point's role going forward will be to fund the priority investments in the department of public health and the service community, while encouraging our philanthropic partners and peers to do the same. we are taking the first steps towards making this vision a reality. today we are announcing that tipping point will invest up to $3 million to create a second hummingbird psychiatric respite center, replicating their -- [ applause ].

>> as the mayor said, this is the type of program you want to replicate. this will expand access to a critical supportive step out of homelessness. we invite all of our other funders and friends throughout the city to explore the report findings out today and invest in the recommendations and join us. now i'd like to introduce two people that are working every day to improve the health outcomes of our neighbors. please join me in welcoming dr. anton nigusse bland, who is the director of mental health reform and dr. grant colfax, the director of public health. >> thank you, mayor breed, for leading the way. if we're going to reform our system of care for the nearly 4,000 san franciscans who are most in need, everyone will have to work together. that's why it's so important to be standing here with our partners at tipping point and

ucsf talking about these common goals that we share and advancing our shared vision. i want that briefly highlight a couple of findings in this report that reinforce our own. first, behavioural health outcomes are health outcomes and they are far worse for people of color. this report points out that black men die as almost twice the rate of white men of liver cirrohsis even though they have lower rates of alcohol disorder. we also found of the people experiencing homelessness, substance abuse problems have a higher incidence. alcohol remains a persistent and enormous public health issue that impacts the lives and

health of many san franciscans. our most recent community health needs assessment revealed that two out of five adults surveyed reported a survey of binge alcohol use. between 2014 and 2016, over 8,000 emergency room visits resulted from alcohol-related issues. we can help. we know how to care for alcohol use disorders. we've already begun to work on the kind of evidence-based approaches to chronic alcoholism that this report recommends and particularly exploring the development of a managed alcohol program. the research is very strong that managed alcohol programs, medications, and treatment can reduce the harms of excessive alcohol use. we can create safety and stability for people if we innovate on this problem together. we need to make sure that proven solutions are applied in a

thoughtful way and extend their reach to people who have not had sufficient access to the help that they most need. we also agree with the report's findings that we should make it easier to get realtime data about our system of care. we are launching the very kind of collaboration across city agencies that this report urges us to purview. we expect to be able to provide this transparent information about our beds and our system of care to the providers, clients, and members of the public so that all of us have a better understanding and is have an improved ability to access care. we know that research and philanthropy will play important roles in making these recommendations a reality. we are grateful for that support and partnership. [ applause ].

>> good morning, everybody. i'm grant colfax. i'm the director of health. i'd like to thank mayor breed for her leadership, ucsf, and tipping point for the ongoing and strengthened partnership that they have with the department. of course, dr. nigusse bland for his bold leadership in his vision for us to do better as a community as we address the intersection of the homelessness and behavioural health issues. this is an important day. we are coming together focusing on solving problems and improving health for the population of nearly 4,000 san franciscans who are experiencing homelessness, mental health, and substance use disorders. today we announced a significant commitment of partnership to meet those goals. a population focus means not only a focus on treatment of the issue patients, but we look at

the big picture. we change the way the system responds when a public health challenge is this great. we learn. we look at the problem from multiple angles. we draw on clinical expertise and data. we try new approaches. we learn what works. we stop what doesn't. we measure results and we built a track record of success. we figured this out when we look at h.i.v. look at the numbers being released this week. we've gone from ground zero in the aids epidemic, to pledging to be the first city to get to zero. that didn't happen overnight. it took multiple stakeholders from across san francisco. we need to use that experience to address other deep health challenges in our city. progress does not happen and cannot happen in isolation. as with h.i.v., we know that

forging behavioural health solutions for san francisco residents experiencing homelessness and health issues will take researchers and clinicians, community stakeholders, clients, philanthropists and the support of the public. i and we are grateful for the contributions of tipping point and ucsf. these two robust institutions that we're fortunate to have in san francisco. the health department looks forward to partnering with them and many others with the significant behavioural health challenges facing people experiencing homelessness in san francisco. together we can and we will heal our city. thank you. [ applause ]. >> mayor breed: thank you. now, i don't know if any of you caught this, but john snow inc.

did the report. you know nothing, john snow? nobody caught that? okay. next up we have dr. matt state from ucsf. [ applause ]. >> thank you so much, mayor breed. truly, i'm thrilled to be able to stand here today with a group of leaders who are so dedicated to this city and to the most pressing social problems we face, including chronic homelessness. more than 30 years ago, at the height of the aids crisis, local government in san francisco health providers, academicia, philanthropy, set aside parochial differences and came together to attack what seemed like an insurmountable challenge. this week mayor breed sat with the department of public health and ucsf to review the remarkable progress that has been made in this struggle and to double efforts to work

collaboratively to be the first city to get to zero, something that must have seemed impossibly out of reach three decades ago. this is the inspiration for our efforts and it is the model that we are pursuing to address the intersection of mental illness, homelessness, and substance use disorders. this report is a product of all these organizations coming together to help develop a consensus road map that develops tangible, immediate differences in the lives of individuals and families experiencing psychiatric illness and substance use disorder. the work that went into it from clinicians, other service providers, and many others. i can't thank mayor breed, director colfax, and dr. nigusse bland enough for your leadership and inspiration. and to daniel leary and the tipping point folks, it's been a

remarkable partnership. we're tremendously grateful at ucsf. there are several other people i want to mention. first, i really would like to underscore a tremendous contribution from jane hawgood and john pritzger for their help to launch this collaboration and bring us together. as you've heard today, it will be the partnership of academia and the city and philanthropy that really promises to allow us to move forward on a critically important and admittedly extremely difficult challenge. ucsf and the city have a long partnership beginning 150 years ago, when ucsf doctors began caring for san franciscans in the city's general hospital. today ucsf clinicians continue to care for the city's most vulnerable, including children and adults, at san francisco

general hospital and in a range of outstanding community-focused programs for those suffering from mental illness and substance use disorders. from our division of city-wide case management, our division of substance abuse and addiction management, our psychiatric emergency services to name just a few. as chair of the department of psychiatry at ucsf, i could not be more proud of our people and our long-standing partnership with the city that has allowed us to work every day to make a difference in the lives of our patients and their families. as a representative of ucsf here today, i can't stress enough our commitment to collaborate in taking on these big challenges, our department of psychiatry, the new homelessness and housing initiative, our students, our faculty and trainees are all determined to work together to find ways to tackle the most pressing health and health equity challenges we face, including the nexus of mental illness, substance abuse, and

homelessness. thank you again, mayor, director colfax, dr. nigusse bland, and daniel, for your tremendous partnership and efforts. [ applause ]. >> mayor breed: so there you have it. let me just say that we all know that the challenges that we face as a city weren't created overnight. there won't be any easy fixes. it will take time. it will take, as every speaker here as said, collaboration, working together, seeking out the professionals who have the expertise in the medical arena and the non-profit sector, our policy-makers to provide the right kinds of solutions. this is so critical because when we look at homelessness and the challenges that, sadly, around 4,000 residents of our homeless community face, we know that it's not just homeless people

who are dealing with a number of these issues in terms of behavioural health. it is time that we take just a different approach towards addressing behavioural health challenges in our city and in our country. that we begin to get rid of the stigma attached to seeking health for people who sometimes are dealing with depression and other issues that continue to plague our society. one of the things that i am really committed to is making sure that we have wellness centers in all of our high schools in san francisco, all of our schools in general, so that when kids are dealing with trauma or any other kind of situation, that they have the help and the support that they need in the place where they study and learn every single day. looking at creative and innovative solutions is how we are going to create a city that is healthy and is thriving. i want to thank all of you for the work that you have done and will continue to do to get us to

a better place with all of these leaders, all of these amazing people, all of these incredible minds. i know it's only a matter of time before we get to that better place that we deserve to be. thank you all so much for being here today. [ applause ]. [♪] we spoke with people regardless of what they are. that is when you see change. that is a lead vannin advantage.

so law enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. >> we are seeing reduction in drug-related crimes in the pilot area. >> they have done the program for quite a while. they are successful in reducing the going to the county jail. >> this was a state grant that we applied for. the department is the main administrator. it requires we work with multiple agencies. we have a community that includes the da, rapid transit police and san francisco sheriff's department and law

enforcement agencies, public defender's office and adult probation to work together to look at the population that ends up in criminal justice and how they will not end up in jail. >> having partners in the nonprofit world and the public defender are critical to the success. we are beginning to succeed because we have that cooperation. >> agencies with very little connection are brought together at the same table. >> collaboration is good for the department. it gets us all working in the same direction. these are complex issues we are dealing with. >> when you have systems as complicated as police and health and proation and jails and nonprofits it requires people to

come to work together so everybody has to put their egos at the door. we have done it very, very well. >> the model of care where police, district attorney, public defenders are community-based organizations are all involved to worked towards the common goal. nobody wants to see drug users in jail. they want them to get the correct treatment they need. >> we are piloting lead in san francisco. close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. >> our goal in san francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention

to address that population and the racial disparity we see. we want to focus on the mission in tender loan district. >> it goes to the partners that hired case managers to deal directly with the clients. case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. >> i have nobody, no friends, no resources, i am flat-out on my own. i witnessed women getting beat, men getting beat. transgenders getting beat up. i saw people shot, stabbed. >> these are people that have had many visits to the county jail in san francisco or other

institutions. we are trying to connect them with the resources they need in the community to break out of that cycle. >> all of the referrals are coming from the law enforcement agency. >> officers observe an offense. say you are using. it is found out you are in possession of drugs, that constituted a lead eligible defense. >> the officer would talk to the individual about participating in the program instead of being booked into the county jail. >> are you ever heard of the leads program. >> yes. >> are you part of the leads program? do you have a case worker? >> yes, i have a case manager. >> when they have a contact with a possible lead referral, they give us a call. ideally we can meet them at the scene where the ticket is being issued. >> primarily what you are talking to are people under the influence of drugs but they will

all be nonviolent. if they were violent they wouldn't qualify for lead. >> you think i am going to get arrested or maybe i will go to jail for something i just did because of the substance abuse issues i am dealing with. >> they would contact with the outreach worker. >> then glide shows up, you are not going to jail. we can take you. let's meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. >> bring them to the community assessment and services center run by adult probation to have assessment with the department of public health staff to assess the treatment needs. it provides meals, groups, there are things happening that make

it an open space they can access. they go through detailed assessment about their needs and how we can meet those needs. >> someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. then from there instead of them going through that system, which hasn't shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. they can offer services based on their needs as individuals. >> one of the key things is our approach is client centered. hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take? >> we are not asking individuals to do anything specific at any point in time. it is a program based on

whatever it takes and wherever it takes. we are going to them and working with them where they feel most comfortable in the community. >> it opens doors and they get access they wouldn't have had otherwise. >> supports them on their goals. we are not assigning goals working to come up with a plan what success looks like to them. >> because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. >> it is all on you. we are here to guide you. we are not trying to force you to do what you want to do or change your mind. it is you telling us how you want us to help you. >> it means a lot to the clients to know there is someone creative in the way we can assist them. >> they pick up the phone. it was a blessing to have them when i was on the streets.

no matter what situation, what pay phone, cell phone, somebody else's phone by calling them they always answered. >> in office-based setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. this has been helpful to see the outcome. >> we will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. >> first to push me so i will not be afraid to ask for help with the lead team. >> can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. it is all part of the home

reduction model. you are using less and you are allowed to be a viable member of the society. this is an important question where lead will go from here. looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. >> if it is for five months. >> hopefully as final we will come up with a model that may help with all of the communities in the california. >> i want to go back to school to start my ged and go to community clean. >> it can be somebody scaled out. that is the hope anyway. >> is a huge need in the city. depending on the need and the data we are getting we can definitely see an expansion. >> we all hope, obviously, the program is successful and we can implement it city wide. i think it will save the county

millions of dollars in emergency services, police services, prosecuting services. more importantly, it will save lives. you. >> when i first moved here people come to san francisco to be the person you want to be can be anyone you want.

>> the community is so rich and diverse that i'm learning every single day san francisco is an amazing photoy town historically been base on evolution and that applies to every single professional field including philanthropic arts today what i do is photo based art manifests traditional forest and some colonel lodge and other frames of digital forest is a meeting that has been changing like super rapid and the quality is not extended by the medium if you took forest in school or you get a job in a newspaper they'll give give you a list of how to create a philanthropic story my goal to break down that model and from a to b that is unique

and allows the ability to incorporate different types of i believey about propels someone through the rise and a fall of their own experiences one of the main things i'm trying to contribute it unconditional narrative form the narrative art of photograph the in between of photos how does a group of photos come together as how to use the space between photos to alight emotional responses from the audience and bring innovation and create bodies of work that narratively function the way that photos do san francisco as the commission came out and you visited me and one of their prerestricts was to find an art with enough work to fill a large says that a quad

down the hallway downstairs and we hung that quad to feel like a train station that constant sensation from all different directions some of the major characteristic of the landscape festivities the blur of the train their 70 miles per hour and they're not perfect as opposed to to what landscape will look like it creates a dichotomy for people insides the train not just the story of the subject it is not just the visual design the composition juxtapositioning, etc. not just all autobiography boo-hoo it creates pictures with meaning within them and then some of the portraits

feel awkward some of them feel welcoming and the person that mime making the picture is really comfortable and other ones feel awkward and weigh i didn't and tense that sensation is counter to what we feel like makes a successful portrait that sensation makes that work it is hard to be an artist in a city is 100 percent focused an business the cost of living is expensive and to value your success not scribble on financial return creates a conflict between the paramount egos in san francisco today. >> you see a lot of artists leaving for that reason because

you need space to make work my ultimate goal to make work that firms people firms this gift and just the experience of life and of their worst and of the amazement the wonderment of everything around us shop and dine on the 49 promotes local businesses and challenges residents to do shopping and dining within the 49 square miles of san francisco by supporting local services within neighborhood. we help san francisco remain unique, successful and vibrant. where will you shop and dine in

the 49? san francisco owes the charm to the unique character of the neighborhood comer hall district. each corridor has its own personality. our neighborhoods are the engine of the city. >> you are putting money and support back to the community you live in and you are helping small businesses grow. >> it is more environmentally friendly. >> shopping local is very important. i have had relationships with my local growers for 30 years. by shopping here and supporting us locally, you are also supporting the growers of the flowers, they are fresh and they have a price point that is not imported. it is really good for everybody.

>> shopping locally is crucial. without that support, small business can't survive, and if we lose small business, that diversity goes away, and, you know, it would be a shame to see that become a thing of the past. >> it is important to dine and shop locally. it allows us to maintain traditions. it makes the neighborhood. >> i think san francisco should shop local as much as they can. the retail marketplace is changes. we are trying to have people on the floor who can talk to you and help you with products you are interested in buying, and help you with exploration to try things you have never had before.

>> the fish business, you think it is a piece of fish and fisherman. there are a lot of people working in the fish business, between wholesalers and fishermen and bait and tackle. at the retail end, we about a lot of people and it is good for everybody. >> shopping and dining locally is so important to the community because it brings a tighter fabric to the community and allows the business owners to thrive in the community. we see more small businesses going away. we need to shop locally to keep the small business alive in san francisco. >> shop and dine in the 49 is a cool initiative. you can see the banners in the streets around town. it is great. anything that can showcase and

legitimize small businesses is a wonderful thing. >> welcome to pricidia middle school. i am emma dunbar and i had the enormous privilege to be the principal in this community. thank you all for joining us. [ cheering and applause ]. >> i want to give a very warm welcome to my students, to our staff, to elected officials, board members, mayor appliapplis