Transcripts For SFGTV Health Commission 41916 20160421

I put the minutes in front of you. Commissioner chow requested a make a slight change on the top 6 page seven. Ill 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 doesnt 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. Im 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 ill 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 stateoftheart 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, its 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 youve heard some of the work that has come out on this lean process and as i said, later this afternoon, well 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 fouryear 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 well 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 estatewise 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, its 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 theyll look at the back builds that are currently vacant and to whoo availability, how can they be used in these areas also that weve 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 were 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 well have in the future. So it gives us that background so we know where were 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 were prepared for the vote. Seeing no extractions, were 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. Its been engaged in Fund Raising Campaign to bring in private philanthropy to support the effort. Its been very successful. The commission has a proofed today 58. 4 million of accepted gifts as associated with that effort. This weve 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. Were on track and spending the money and managing within the projected budget so were 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 were 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. Were 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 . Its unbelievable to have these kind of people in our community. Absolutely. Its been an incredible effort. Weve 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 its not just great for the hospital but great example of how private philanthropy with can work for public hospitals. Were trying do as much as we can. There cant 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 well have further projects. We sat with home to in their Strategic Plan as well and were meeting with them on a monthly basis, greg and i. Keep them ingrained in what were doing. Exactly. Id like to thank our own commissioner sanchez for representing the commission. Im sure thats 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. Its astounding to see commitment there. I just want to say i concur. Its an ongoing 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 well continue to have opportunities to work with them. Them. So at the resolution, weve 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. Im the directer ffer for foster care Mental Health. One of the trauma inform Care Initiative which is what were going to talk about right knew. Get my glasses on. Its right in the middle of the screen. This one. Thank you. Youre 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. Im 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. Were 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 Africanamerican 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. Thats what our clients and patients are coping with on a daily basis when they come through our doors in the department of health. Thats 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 evidencebased practices to address trauma on an intervention level, one o to one intervention level and even family level, until we have a system thats a Healing Organization, its just a practice that we do. I could be the best welltrained therapist in the county, as long as my patients are experiencing trauma and stress,. My hour with them isnt going to hit the mark for our patients. Were 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 werent 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 traumainformed 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 were 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 cant make meaningful lasting change in our silos. We have to come together and learn how to collaborate. Weve 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. Its 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. Theyre now our employees and ask them to serve the community which they grew up in. Its 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, weve 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, were not in tune with ourselves and people around us, were 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 cant sustain this going forward. We have a model which well talk about in a little bit which includes Leadership Development. Even as far as our funders go, when were vying for funding many of us do the same work in this very small county. Were competing against each other. Were 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, were in this traumaorganized 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 . Were going to the traumainformed 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 traumainformed system is the first step. Whawe want do is be a Healing Organization because thats our job in Public Health. To help people heal. Help families heal. We want good communication and collaboration. There is not one way to make a traumainformed system. This is one way. If nothing else, one of the core messages of the threehour training that we with our staff 100 people at a team is asked them to shift their perspectives. Were very, very used to asking what is wrong with people. What is wrong with you if youre upset . What is wrong with you if you have an ailment if and youre 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 dont 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 evidencebased 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, were not a machine. Were made up of people. Were not really doing output. Were not its not about output. Its 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 theyre 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. Were 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 whats inside the house is all of our traumainformed care practices, all the interventions that we spent money training people on. If ear training people and theyre 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 cant continue to function that way. The furniture i be side is protected. Our evidencebased 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 traumainformed system are almost mirror images of oach each other. Theyre 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 frawminformed lens and racial humility lens to collective impact and lean, well have an environment that is conducive to the healing and growth were looking to achieve in the department. Here is our slide on how were doing all of this. So teaching, weve taught over 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. Were training people who have interest in in this work. Theyre not necessarily teachers or leaders. As we define them, but maybe theyre clerks and maybe theyre 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 theyre 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 twopage 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 theyve learned and make the small change weve 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 email two months later to find out how theyre doing with their change. And i think i sent you some of the outcome data. We can look at it. I wont spend too much time on that right now. This is just another way to show you how were 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. Selfassessments. When the staff are done with the survey, selfassessments 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 theyre reflecting on what they want to look at for themselves. Every component of the evaluation is about transitioning the knowledge into action. And i dont 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 its not going to be easy to apply and theyre really worried our leadership is going toe abandon this initiative that it wont get the support it needs and will be poorly implemented. Were 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. Ill end with letting you know that weve now been recognized nationally by sampsa in order to take our model and make it a regional model. Were the lead department in six countyeffort 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. Theyre mostly impacted by trauma and theyre the least likely to get traumainformed 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 traumainformed 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 dont 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. Theyre training their own trainers. Theyll have their own master trainers based on our model and well work with them over the next few years. Were looking at all the initiatives through the traumainform 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 im 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 threehour 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. Wed 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. Youd see simple pictures of brain. Wed 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. Im 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 selfregulated. 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. Im very good in the morning. I get my emails done. If you work with me, youll 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, youll 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 im confused. I have a stress reaction physiologically happening. I can either stand in front of my computer and think its 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 email, i have a deadline, i dont know what to do, i need help can you help me. The coworker can say lets think this through together. Thats how relationships matter. Thats 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 inhome visitation. Asthma treatment but how do we have the conversation that racism matters. Cultural responsiveness matters and when im 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, im triggered. Give me a minute, let me come back to you. You might get more of my east coast italian Girl Attitude versus what youre saying youre hurt, what can i do to repair that. Were 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 followup 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. Its been lifechanging 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 youre 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. Its 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 wouldnt 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. Theyre 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 cant hear this any more or i cant 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 stressrelated 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 theyre 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. Theyre not bad or wrong. They dont 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 theyre 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. Im 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 topdown way of doing things which is fine, it works. Biew we need a bottomup 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 couldnt do this at work. How is it that some people can, you know, take time and do this and others cant . So i think if we think about there is a how do i explain this, ill just say it. People are afraid. People are afraid to peek up, speak out, have hard conversations can theyre afraid theyll have a negative performance evaluation. I think its 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. Im not sure im answering your question exactly. So help me if im not. Keep ask asking because i want to clarify it for you. Maybe ill ask director garcia. If thats the feedback that is needed, do we have mechanisms or is it your vision of this process that there would be that bottomup without consequence in terms of im 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 well 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 ive 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 theyre problematic employees. Did we create them . Or did we hire 20 problematic employees. I would say latter is true. Because of the trauma theyre dealing with and were not dealing with them, this is one of the reasons in all of our work were doing, we are rae trying to provide people support like debriefing those who do some of our Emergency Response pieces. Were learning as were doing and thats a great question because we have this set up a mechanism on how to enforce this. Thats why were 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 theyll 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 Africanamerican Community as well as the Latino Community in our services. If you stretch that out to our communitybased 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 were 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 were 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 weve 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 cant 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. Im 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 wasnt because im not a good clinician or dpoant know my job, its 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. Thats 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. Its really an example across the straight about how its the only its like a hybrid we share funding 50 50. Its 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 isnt 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. Ive 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 its so important it doesnt 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 sitting in their chairs like prove it to me. Prove it this is going to stick around then maybe ill invest in it myself. I think we have early adopters. We call them lowhanging fruit and people that are more cautious and thats fine. They have to be around it. They have to experience it and taste it and feel it themselves then we have people who are no matter what you say, its going to feel like we are giving special attention to some people and not others because they have trauma. And we have to work on that. So we have to it is a horizontal approach but its bottomtoop. I think the 2pointal , theyre the people that have a hard time trusting that we mean what we say. There is no funding. Were doing it from the inside out. Its not like were going to lose funding. Were doing it. This is not costing a lot of money to the department. Were not relying on external grants or consultants or anybody coming in from different parts of the droin. Were doing it ourselves. No matter who leaders are, we want to create the change and embed it into our policy and procedure. This is the traumamanufactured care 1. 0, there a 2. 0 ready to go . Thats a good question. Right now, let me go back to this slide here. You can see that what will is happening next and from the workforce training on its getting the master trainers so we can train a thun people at a time. Thats going to take 10 years. If we can train more people simultaneously, thats better. Were trying to get the trainers trained. Those people are not necessarily teachers and trainers. They didnt go to school to train people. Theyre doing their regular job and think they want do this so they need support on how to be in front of people pand how to speak. So we do that for them. The culture change is about probably a decade. We would see some real change in about next 10 years i would say. I think that embedding all of this in all these different areas is the next step. The 202 102 happens at the champions level. They take a deeper dive into the principles and concepts. Theyre developing within their cohort ways to feed back to leaders and directors so we can embed it in the pilots that we have all over the department. With the champions embedded in the pilot. Because we understand that the culture is different in each agency. What works for mine is not going to work for yours probably but we have to figure that out. The champions are doing the next level of understanding. Looing forward to having that number go down. Commissioner pating. First of all, i had the honor of listening to dr. Alicia lieberman from the department of Public Health. Im with you on the importance of traumaticinformed care and the science of frawminformed care. I think what traumainformed care so youre doing is bold, i see what youre doing that leads you in terms of strengthbased probes so soon orr later maybe we can push or nudge the title of this initiative from traumaticfocused to resilientbased initiative. Then i have two small questions. A comment that we definitely i completely agree with you. Throughout the training, the threehour training, you hear a lot of hope in the curriculum. Because we are really telling people, this does not dech you or your patients tream. We end with a patients trauma. We end with a module on resiliency and recovery. From there, were bringing in science from the Greater Good Science Center around mindfulness, gratitude and how you can embed that in your own personal life and agency. I agree and really, i think the goal is to not even be a traumainformed system but to be a Healing Organization. Wellnessbased. Absolutely. So another organization Mental Health services had a similar mission. Are you use anything monies for any of the activities . Not currently. We use our own general fund monies . Were not really what were doing is i think part of what you see from leadership is this idea that as the director, im going to forgive your productivity while you do the champions work. Thats how we use the departments money. The second thing is with regards though this being so much a traumaformed care or developing this is as a culture change, it starts with an approach to a culture of care as opposed to a culture of choice. Moving to as a client to the center of decisionmaking. How will we know we are there . One of the aspects is youll look to train so many people. But then after that, there is a training people to do certain acts. What will be some of the concrete things that youll feel you have a first lel level of adoption . I have some thoughts on what might work. Well, the competencies that we developed that are in one of your handouts, defines the principle and then lists the competencies. At some point well go back and survey everybody and find out where they are. How competent are they in each of these principles. Thats one way of looking at it. Another way of looking at it is we recently did a whole staff survey, for the department. And im not i didnt really ever look at those results. I know we did that. I dont know how many people responded and i dont know exactly what the results were, but well do another one of those through a traumainformed lens. I think continually and well expect to see a lot of improvements na souray. Sur in that survey. This is about how people feel when they come to work. Thats going to impact how well they can do their job. Those are two things we can look at, ex competencies, climate based on surveys and i think were developing other tools for measurement as we go. Were learn big doing. If you have other ideas, i would love to to be able to consult with you. I see this as a whole climate shift. Its a climate shift for wellness grated into the workforce which impacts patient care and efficiencies. This is looking at a double whammy you get. Where we try to deal can this in the Mental Services act well Key Healthcare values and its hard to measure but measuring the adoption of values is good. Patient care is dissal like 10 years maybe even 15 years before youre able to demonstrate this person got Faster Service because of this. Our hope is that, but i dont think we should expect it right away. If we start is to see some of the values get into individual staff members, annual improvement plans, im going to take this activity up in order to try to further this trauma system strawm pour system in our system. Youll see these individual meshes of adoption that were transforming. I want to commend you on this. This is bold and im excited to see this will even though it will take some time, its the right thing to do. Commissioner singer. Id love to come back with the discussion you had with dr. Chow and pick up on comments that were made. Maybe you can tell us what your challenges are with your staff, getting them to be more my sense is more permissive with their organizations to allow this to stick and flourish because it sounded like this was not just for this to flourish, it wasnt just an issue of people going through training and adopting it, but it was more how we work as a department and sort of what sort of changes are you putting in place so that we can learn from this and it can be a durable part of our culture . I think its middle changment that i get the most concerned about in terms of the fact that i feel that that is reflective of the racial humility component of it. Iand it has do with how and who we hire for the department. Part of the i feel like we have a good leadership component. As we get into middle management and we have people here for 20 or 30 years that watched five directors go and come. I think i counted a hundred great practices that we accepted and let go of, its this collective impact that you take a few things and drive it and drive it. Where we need to focus is with middle management and that needs to reflect who we serve. Thats the component were going to be having probably a good 20 of our employees who are going to retire. In the next five, 10 years, probably five years i would expect a large portion of some individuals will retire so well bring new leadership in as well. There are several components to your question, it isnt just how do you fix it, it is how do you continue to improve it in terms of the process. Thats why its so important in the next couple of hours youre going to learn about le lean and how it involves in our improvement of quality and Leadership Development. Cultural humility is another area, were a government agency. And commissioner singer, you have tried to champion this thing about issue about lyring and how we do that. Thats also a struggle that we have within the Civil Service system. So and then the other area, the responsibility in the community because as i think this training also helps the providers serve our clients better. Its not just to make them feel better about the trauma, but how to thenar help our clients not asking what is wrong but tell me your story. That is a completely different paradigm. So were trying to not just do one, but several of these issues and we have a fiveyear plan to see how we are ago go to move the system as a whole. Its a complicated answer. But its also one that i believe that we can, by moving more new succession and new development and knew leadership in the department and ensure that those who want to work with us have a real focus of the communities we serve, know how to serve them welcome well and are trained appropriately to do it and have the tools from h. R. Csm from performance or the leadership to ensure is that were driving those possibilities and those improvements down. And i think having a Frontline Worker as a champion and lean is in that direction as well. How do we involve our workers into the betterment of our services. I kind of see a multiple process but it has to do with watching an institution as it grows and changes because its never the same due to the fact we change as people. Our communities have also continued to suffer in our inability to serve them well and thats the major focus we have to keep our eye on. I think the fundamental problem is for persons who have suffered chronic trauma, its not everyone, but for many people because there is an inherent resilient factor, its constructive to relationships. When you scrupt relationships, it disrupts the whole system in help seeking and service seeking. One of the things youll hear about in our homeless community, you could have the best clinic in the tenderloin but people will wander back and forth because of apprehension of entering the clinic and all that entailed. This is where if you focus in on relationship, hopefully services can fall and we need to be relationshiporiented both in Cultural Diversity perspective and in a socioeconomic or developmental perspective because of the impact on a relationship. I think thats my understanding of our focus. But its people are coming with what they come with, their strengths and struggles. Both staff and patients and helping people be selfaware of those struggles is one of the aspects where you can move people to their strengths. Thats what i see you doing. I would add going back to commissioner ca karshmers question to me, 2. 8, theyre not sure. Trauma creates helplessness and hope unlessness. And we cant do anything to change this situation for myself. I think we hear that. We see that reflected in our staff quite a bit where there might be a good idea that they have but feel like they cant make an impact because theyre not a leader. A lot of what we do in trauma 101 is give the power back to people and say this is a learned response you had as a result of stress and trauma in your life and you can unlearn it and ask you for your ideas and say you doesnt wait for this person over here do it. Do it yourself or do it in relationship with other people but you can actually do it, you can make the change. This is where you empower staff and they can empower patients. Exactly. With trauma, you have more avoidance coping. Thank you. And srml certainly this is a new process and i believe that we would like to be able to have a followup on how the initiative is coming. So i would assume in the coming year, we will have the director bring this back as an item when she feels that she can then show the further development that they are moving on this. I want to thank commissioner pating for adding the elements that you have and bringing the experience that youve awe brought from your state background. One last question, is the issue of cultural humility separate or a part of this . It comes together. Ken haring is our trainer in that area. Those are the four areas that lynn mea be can show. Right. And we were going to bring that also today, but the trainer was away today. So well bring that to the commission also. Because were serving racial and cultural communities in order for us, you know, to be able to do our job better, i believe having conversations we should not be afraid of that. That has a great impact on care and especially if you are not africanamerican and trying to serve an Africanamerican Community, its tools youd need to know and understand how best to surve that community. Having those four areas and this is what were looked at for Workforce Development priorities and something that dr. Otagon and ourselves are working on for our Leadership Program is looking at how we can impact our care and workforce for this training together. Usually you see this separate, we want to bring it together so people understood the connectiveness. And dr. Hardy provided a lot of that around that principle. Weve integrated his work into the principle. Thank you so much. Thank you. And well bring the racial humility initiative along with cultural competency report to the commission to fill out this development initiative. Thank you. Our next item, please. Commissioners, i believe you may consider recess at this point. Move to another room. And president chow might want to Say Something about that. Were going to be recession so that well have a different environment public of course is invited and they can continue to join us in room 220 and well reconvene at five minutes. 3 30. O sfgtv meeting fgtv of the commission on Community Investment and infrastructure occurring on april 19, 2016 will begin shortly. It is 105 p. M. This is regular meeting of commission on Community Investment. The Successor Agency to San Francisco Redevelopment Agency for tuesday april 19, 2016. Welcome to members of the public. Madam secretary can you call the first item item 1, roll call. Please respond when i call your name. Commissioner pimentel, present. Commissioner bustos is absent. Commissioner singh, here. Vice chair mondejar, here. Madam chair rosales, here. I have commissioner bustos absent and all other members are present. The next order of business is item 2, announcements, a, the next regular meeting will be held may 3, 2016 at 1 p. M. At city hall room 416. B, announcements of prohibition of sound producing Electronic Devices during the meeting. The ringing of and use of cell phones rkss pager squz similarly sound producing electronic deviceerize prohibited at this meeting. The chair may order removal from the meeting room of any persons responsible for the ringing of our use of cell phone, pager orother similarly sound producing devices. C announcement for time allotment pr Public Comment. A mb of the public has up to 3 minutes to make comments on each agenda item unless the commission adopt as shorter period. It is strongly recommended members who wish to address the commission fill out a speaker card and submit that card to the commission secretary. The next order of business is item 3, report on actions taken at a closed session meeting if any. There are no reportable actions. The next order of business is item 4, matters of unfijsed business. There are no matters of unfinished business. The next order of business is item 5, matters of new business consisting orphconsent and regular agenda. First concept. 5 a, proval of Meeting Minutes for december 15, 2015, march 1, 2016 and march 15, 2016. Madam chair. Yes, do we have speaker cards on the consent calendar . We do not have any speaker cards. Commissioners do we have any questions, comments, edits, motions on the consent calendar . Approve a motion by commissioner mand har and seconded by commissioner pimentel. Please announce your vote when i call your name. Commissioner pemental, yes. Commissioner bustos is absent. Commissioner singh, yes. Vice chair mondejar, yes. Madam chair rozauls, yes the Consent Agenda is adopted. Please call the next item. Next order of business is regular addenda item 5 b. 5 b, authorization an aumgz grument with f 4 Transbay Partners llc, Delaware Limited Liability for purchase of block 4 on the nern 1 third bouned by beale howard and main and fol son street. Successor parcel number 3739. Portion of lot 008. Transbay redevelopment projeblth area discussion qu action resolution number 18216 good afternoon to commissioner jz public. Thank you for joining us. The matder for your consideration is approval of option agreement with f 4 Transbay Partners. As you will hear in the staff presentation the option agreement sets forth the terms for a specific price 45 million subject to other terms and conditions as well as provides significant parameter frz Community Investment and benefits, including a High Percentage of ow fordable housing funded by the develop squr other Community Benefits that would be negotiated as a part of the disposition and development agreement. With that, i like to ask sally [inaudible] Deputy Director to walk through the backgrounds, the key terms for the option agreement and related term said that the tjpa approved. The recommendation and next steps. Thank you. Good afternoon. Sally. It seems like everyone in San Francisco is talking about housing San Francisco housing prizes are among the highest it tops anyone Million Dollars and rent rise unfortunately, this is not the first time housing has been in the news thought california the cost of a home has made headline the medium prices for a house in the the 207,000 in california it is more than twice that amount and the laura u bay area is higher its more than doubled the states so while more than half of the americans can afford the medium fewer in california and quarter in the bayer and now fewer than a 6th of san franciscans can afford it so why it housing in San Francisco so go cheven condition tharz the obviously a high demand to live here the city is known for cultural diversities that attacks new residents and the credible opportunity our city diverse and will daytime committee grows jobs as a result we estimate the number of jobs is at ann an alltime 0 hive of 6 hundred thousand in the 80 the population was 6 hundred and 75 thousand now, its grown steadily and quickly the recent estimate is 8 hundred and 40 thousand the highest in the citys history and its not only San Francisco it is greek the bay area has 2 million for residents and jobs then in the 80 and the growth is expected to continue by the year 20403. 9 Million People unfortunately, our housing supply does not keep up with the demand i might not realize the majority of construction is housing thats been suspended for years due to the 2008 recession while population is increasing the housing is only increasing that i 9 percent if we dont pursues housing the cost of housing about only increase how do we plan the regional allocation identifies the total number of housing unit by affordable level to support the new residents San Francisco incorporates it into the housing elements that guides the housing policies the arena data places it in the investment plans for the growth throughout San Francisco those plans developed by years of Community Planning laid the ground work for the construction so the city he e sets the goals in broad terms the private sectors builds market rate housing and nonbuilt Affordability Housing that majority of housing in San Francisco as well as throughout the Country Market rate houses built by private developers within guidelines of the city some below market rate you howls paid pie public and private dollars and prized to be variable to certain population housing is considered affordable if it costs less than 1 3rd the medium income for a 2 percent householder is 70,000 this householder will have to pay no more than 7,150 to be affordable San Francisco has see long applied federal, state and local money often built and nonprofit tint for individual families the news cities in california what the Inclusive Program requires that 10 or ottawa more units to certain blow income levels or contribute to the fund that supports the blow market rate unit almost 25 thousand have been supported by city funds and more than 6 nous thousand of the unit were built between 2000 and 2012 what you cant afford a million will home youre not alone in response San Francisco mayor ed lee has set a goal of creating thirty thousand now emails homes by the year 2020 most will be in outreach of the san franciscan with federal and state funds drying up the San Francisco Ethics Commission is, taking an iv i of actually roll is providing housing across all levels were working diligently for everyone to live here and mr. Chair protect the housing semiand strengthen goals against evictions were commented for Housing Needs for all san franciscans to learn more visit highway the office of controllers Whistle Blower Program is how City Employees and recipient sound the alarm an fraud address wait in City Government charitable complaints results in investigation that improves the efficiency of City Government that. 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