City of San Francisco sfgtv meeting of the budget and finance subcommittee occurring on march 16, 2016 will begin shortly. Good morning welcome to San Francisco board of supervisors budget and finance subcommittee meeting for wednesday march 16, 2016. Im mark farrell and chairing the committee. Joined by supervisor tang and norman yee and want to welcome Supervisor Scott Wiener for joining. I want to thank linda wong and gym smith and leo [inaudiblefrom sfgtv for covering the meeting. Please silence cell phones and electronic devices. Speaker cards to be included as part the file submitd today the clark and appear on the match 22 board of supervisors agenda unless otherwise stated thank you if you would call item 1. Resolution authorizing the children and Families Commission to accept a grant in thumount of approximately 2. 6 million from California Department of education to support a preschool policy [inaudible] july 1, 2015june 30, 2016. We have [inaudible] here to speak on the item. Good morning supervisors. We are very happy that the city of San Francisco is receiving 2. 5 Million Dollars from the state of california to reward all the programs that have been participating in the federal race to the top quality rating and improvement system. This was a ward given to california along with several other states through the race the top and fart of that reward required the state of california to implement a qualityerating and improvement system for all the programs in the state of california. Because the state at the time when they received the award, they were only able to implement the qualityerating and improvement system in 16 counties. San francisco, we happily volunteered to be one of those counties to pilot the qualityerating and improvement system and what it is very similar to for those who have kids in public schools, it is similar to grade school, accept that it is really for birth to 5 for centers serving children. A byproduct of that is there legislator set aside 50 million as part of the initiative and the state programs are getting through the award that William Techmseh Sherman hopefully accept a incentive. Not only participating and reaching a hire level of quality on that rating cyst. Thank you very much, supervisor yee. I will say we are getting to accept the award, i just want to say that even though it is something that is coming from the feds to the state to San Francisco that actually San Francisco has always been ahead of the curve and it this compliments the things we have done for the past decades and because of that we have the first 5 taking the lead. I want to make sure we acknowledge [inaudible] has done thank you. For our program, thank you very much. Thank you. Colleagues, seeing no comments well move to Public Comment. Anyone wish to comment on item 1 . Seeing none Public Comment is closed. Send forward with positive recommendation. Motion by supervisor yee and second by supervisor tang. Two, authorizing the controlling to enter into agreement for soft weir license and [inaudible] support service with [inaudible] it is in the Contract Term 5 years and increasing the expenditure to appreciately 14. 3 million. Thank you very much. Controllers office here to speak on this iletm . H item . Dennis mu cormic active director of the [inaudible] controllers office. Supports the Office System which is hr and pay roll system the city yeezs to pay the employees. Thank you for taking the time this morning. Move very quickly, just some information on the large contract we have in front of you. Back in 2007 we went for a competitive solicitation process to identify the software we want to use to run the cities pay roll benefits and at that time we selected oracle and sense that time we amend the contract to keep us under support so we are able to apply patches and fixes as they become available and upgrade the software as it becomes available. We have gone through 9 amendments and in front of you is the 10th amendment. So, the 10th amendment will extend the support from april 2016 through april of 2021. It allows us to apply security fixes as they become available and upgrade the software as new releases become available and if something breaks as often hapbs with software it means oracle will be there to fix the break and that is the key part the contract we are taking advantage of. We pay 860 thousand a year for that. Just a little background, why are we going with 5 wreers opposed to 1 year . Be are able to lock in additional savings. We project we will avoid 250 thousand dollars in expenses from a 1 year to 5 year increase and made investment in the oracle system in the last 10 years. We added on e learning management and [inaudible] the city made the decision to go with the oracle Financial System and will do integration there so we do know this is a long Term Investment so we just feel in extending for the additional period of time will give cost saveies to the city and know we will use oracle over this time period. Just want to thank the Mayors Office and the board budget analyst for working through the process. It isnt the most clear contract but it was a nice experience wurbing working with them. If you have any questions happy to take them at the time colleagues any questions. Seeing none, mrs. Rose. Yes mr. Chairman and plebs of committee. Supervisor wiener on page 3 of the report we know data out of the Controller Office not to exseat amount of 9, 757, 446 is extended to date on the license and Software Agreement with oracle. Under the last year the existing agreement the Software License and Maintenance Cost is 803, 688 per year and as you just heard under the 10th amendment to the agreement this will increase by 56, 491 or 7 percent. [inaudible] we recommend you approve the resolution. Thank you very much. Mrs. Roseany questions or comments . Seeing none Public Comment is closed. Can i entertain motion like to make a motion to send this to full board with pause positive recommendation motion by supervisor tang and take that without objection. Item 3 hearing on transgender youth issues for policy and budgetary needs and request department of Public Health and childrens and families to report. Colleagues this item was sponsored by supervisor wiener and thank you for doing so. Turn it over to supervisor wiener. Thank you very much. Thank you mr. Chair and committee and thank you for hearing this important item today. I requested this hearing in order to discuss the various issues and challenges and confronting our transjnder youth population including children and adolescents and discuss what we as a city are doing and what we can do to support these young people. We are seeing not just in San Francisco but throughout the country an increase in the number of school age use adolescents and younger who are transitioning genders. We are seeing more and more young people who are more comfortable stating who they are and living the life that is right for them. These young people face money challenges including stigma, discrimination, bullying, physical violence, misunderstand, some without Family Support and some with lots of Family Support and lack of access to health care. We need to do everything we can to support the young people. Today well discuss what we are doing and can and should be doing to support our youth. We have representatives from department of Public Health, San Francisco Unified School District and child and adolescent gender clinic. We are fortunate in San Francisco to have some the most progressive policies around the [inaudible] the department of Public Health and School District have been working to imp lment very progressive and forward looking policies to meet the needs of our transgender neighbors. Several years ago i authored legislation at the board which colleagues you passed ask i they think for that to make sure we have full access to healthcare by transgender people as part of the healthy San Francisco Program Including access to needed surgeryries. We passed that unanimously and there was coverage in the paper today how that is working increasing access. We are fortunate to have great institutions inl San Francisco like ucsf which is leading the country and world working with young people. Colleagues i hope todays hearing will be informative and have a discussion how we as a city can be even better supporting our transgender youth. If there are no introductory comments or questions i would like mr. Chair to move to our presentation and start by asking julie Graham Department of Public Health to address the committee. Good morning. So, im july graham and director of Transgender Health service and this is bare [inaudible] our medical director and well talk quickly about what it is we are doing in dph. So, transjendser Health Services is committed to improving access and quality of care for all transgender individuals served by San Francisco department of Public Health, adults and children. What we do is consult and advice with dph clinicians and Mental Health providers to make sure they are providing adequate care and do a phenomenal amont of training and we help individuals access that care. We problem solve and provide support for gender afirming surgeries when they are medically necessary. The other thing we started isyou get to do dimensions. Thank you,bery [inaudible] i want to speak about dimensions clinic, this is the queer youth clinic provided through the department of Public Health for San Francisco. Dimension is in the 18th year and provides medical and mental Health Services in a comprehensive way for self identified queer youth. This operates two half days a week at convenient times, thursday evening and saturday during the day. Multiple Collaborative Program with Health Providers from department of Public Health and Castro Mission Health Centers [inaudible] lyric and actually numerous other people who are involved in helping this presentation. 91 percent of the patients are identified as transgender transsexual or gender non binary. And over the past 18 years the percentage of trans youth who utilize the service arehas been increasing pretty much every year. Um, of the current people seeing all of the patients are under the age of 25. 22 patients are under the age of 18. Most of the patients coming in are initially coming in with inquiries about accessing hormone care for hormonal treatment of gender dysphoria. 60 percent of the people seen are people of color. Our program in San Francisco creates access for individuals over the age of 18 to access to transgender surgery and we have been providing those services. We provided completed transgender surgeries for 2 youths in the age range, 1822. So the cdhs side, children youth and families, each clinic has a point person whos job is to handle every concern and question that comes up arounds providing appropriate care for children who identify as gender non conforming or families where a parent is transitioning and the family has struggles around that issue. The clinicians consult with barry or i or a team and we help them identify resources including medical and surgical and school intervention. We consult with ucsf and several other programs when we need specially services. We also have a website where we keep information that is accessible to everybody around referrals and resources that are available. We are just starting muntly [inaudible] base d on the concerns and ideas and the spinge issues patients are bringing to providers. We do massive specialized training in addition to the mandstory sensitivity trainings we created for all of dph that we refer to as trans 101. When the individual clinics have grand rounds we rotate through clinics to encourage attendance by non specialist clinicians and expose everybody to the different clinical concerns related to diversity from the clinics throughout. Currentsly that is what we are doing in dph related to transgender youth seeking services through dph. Thank you. What is the age range that you are seeing . So, dph takes care of everybody. Transjendser Health Service sees people 18 and over and has provided two surgeries in the transitional age youth group. The other clinical work is for children of all ages. Are youwhat are thein terms of the youngest ends, for the committees information, how young are some of the kids you are working with . So, clern children youth and families have Elementary School youth that are gender non conforming working with providers and their families. On the medical side people have to be over 18 to access surgery. On the medical side the primary care programs are dealing with children at all ages as well and have the capacity to do that. Thank you. Okay, next mr. Chair i would like to ask San Francisco Unified School District kevin grogeen director of safety and wellness. Eric martinez and lgbt coordinator. Kevin goingen director of safety and wellness for San Francisco unified. We were asked and the powerpointthere we gowe were asked to give a brief description of services we provide in San Francisco unified working with our transjnder gender exspanseive students and to do that we thought we would take a look at the data we have to support our work. We are San Francisco unified is a cdc sponsored financed city for of our programs and as such we implement the Youth Risk Behavior survey annually since september of 1990. The most recent survey as you can see here, we reached 68 percent of our middle School Student and 82 percent of our high School Across all of our high schools and this randomized sample. We also in looking at our demo graphics, we have probably national ly the best consistent data over the past 20 years looking at our Sexual Orientation and gender yite identity. In terms of middle school for Sexual Orientation the glb and not sure which we count as q is there and the gender identity we have 5 administrations on two different surveys of our students and we have consistently been at about 1 percent of our middle School Students identifies as transjnder translated to about 100 of our middle School Student. High school Sexual Orientation, this is fairly consistent for the past 10 administrations and again, for our high School Gender identity we have pretty much settled into about 1 percent translated to about 150 of our high School Students identifying as transjnder. If we look at the student who identify as lgb we look at racial and ethnic make up. What we see from middle school is the vast majority of the lgb student in middle school are student of color. 20 percent in middle school are white. If we look at high school the poc, people of color population increases so the majority of the lgb studerant students of color and 10 percent identify as white. As we look at the break up of student who identify as trans by ethnicity you can see the shadows row ochb the midm and school and high school it herfbs around 1 percent we are looking at in terms of the total population. Our evalwaiter wanted us to say we have a low cell count when we break these down but it capture as picture of us in terms of the work we do. How do we use our numbers to inform our programming . Within San Francisco unified we have a multiteared system of support to scaphold how we support our students starting with a universal tear, it is something all student have access to which includes student rights, Inclusive Health and social studies curriculum and celebrate lgbt pride. Last year we saw 120 events across k 12 and on going assistance in trauma, suicide prevision and Substance Abuse. We meet with student and school staff to look at support plans. We also provide a lot of promotional materials, posters, buttons, wrist bands, we have had all. We also provide a lot of these clinical suvs squz support services through the High School Wellness center and access to School Social workers. We provide ongoing assistance for supporting and implementing the transgender policy which reidateathize state policy by about 10 years. We have the gay straight alliance, gsa day and psychoeducational groups partially funded through the center for disease control. The support groups which are beginning to show positive attendance for student accessing the groups and coming student to school more and young mens Health Groups which show positive effects in the same way and more intensive onsite counseling. Referrals for mental helths and Sexual Health on site and off site and linkage to Community Resources and planning. Most of our efforts in a structured manner are focused on the secondary schools, so middle and high schools. However, we have been providing and are leaving here to provide Technical Assistance and resources for families of Elementary School students. We have more and more children entering the district with families are advoivating for them as gender variant, transgender, whatever the term the family uses we work with them to address that. What happens if lets say a 5th grader in Elementary School talking to a teacher or a administrator in school and expresss he or she is gender non conforming in some way or transgender, whatever the terminology a 5th grader might use, what wouldhow would the school be expected to respond to that . Well, what we have found is our kindergartners are very articulate around their gender vocabulary when it comes to their identity. Usually if a young person is speak ing to a administrator he or she is very clear on how they may identify. Administrator will often times connect with the scoom social worker or school nurse. Every school has a social worker and 39 percent have a School District nurse. That may be the first point of contact then the calls comes to us. First we work with the student or ask the student to see where and what is going on at home because we have a broad range of exceptance in home situations. Assuming the parent and family at home is on board with where the student is we work with that student to be sure that whatever services, whatever representation that Student Needs is met and so we have some students who identify as who present themselves as their identityed jnder but know one knows but the School Administrator and social worker and have others who are broad about the process. Does that answer . Yes, thank you we are the First District nationally and one of the first in the state to successfully follow the state law what must be kept in records and change the roster to identify the gender identity and name of a student. This was just a sample of what wethe form we use to put it in here for you to see. We do have had computer glitchs but it is a system that seems to be working who want this. The challenge is we need a parent signature for this piece, so that if we have a older student who may want something changed on the roster we have to have a signature of the family for this. Here we wanted to give a overview of a lot of the Community Partners that we work with who provide consalitation or support. A handful of the folks are contracted and paid to do some the programming we just talked about and some have mous the district to implement programs at our school sites. This is just a shot of our website, the number and resource s and policies are on here and they go to this. If there is issues or concerns that come up the curriculum is here. We have k12 that addresses gender. Most the curriculum in element is based on kid let and limited but expanding that this year with greater resources on that topic. That is it. Any questions . Great, thank you very much. Mr. Chair to call up our final presentation, the most substantive, the [inaudible] it is lelthy powerpoint so if we can ask the presenter tooz be efficient moving through that that would be great. Thank you very much. We are grateful to supervisor wiener and to the board of supervisors for recognizing the importance of addressing the needs of transjnder youth as supervisor wiener said and often misunderstood marginalized population. We bring the perspective as a multidisciplinary steam team to detail the challenges the youth face and explore opportunities to partner with the city of San Francisco to improve the lives of theesh vulnerable youth and their families. We would like to begin by sharing the real life story of a patient we serve. This is a 13 year old who was assigned male at birth and from a very early age as early as 3 expressed to the parent i am a girl, why do i have penis and daunty wanted to use a girls name and clothing. The parent that this was a phase and at a loss but because don tay was so persistent they wnt along with this. During the childhood years there was significant anxiety and depressions that worsens with onset of puberty and by the age of 13 the child was referred for medical support and [inaudible] that can be life saving, these are called pubetle blockers. Medical treatments was denied and that led to the 4th prong of service for legal support. I would like to give a brief overview of our teams presentation starting with definitions, address one of the things that came up in the other presentation prevalence, risk and impact of parental support and model of Multidisciplinary Care and the barriers the youth face and strategies moving forward. First, never imagine defining sex in San Francisco city hall but we are talking about the physical sex characteristics that at birth lead to someone saying you have a boy or girl so we are talking about the genitalia. In contrast, gender identity is ones inner sense as who ones is on male or female and it is important to recognize that gender identity is confused with Sexual Identity or Sexual Orientation but these are distinct aspects and any person of any gender identity can have a Sexual Orientation. Transgender is a term where the persons deep sense of who they are is not in alignment with their sex assignment at birth. How come it is transgender . It was mentioned in San Francisco the prev lnls is as high as 1 in a hundred. There was a study published out of boston which surveys 28,000 adults and 1 in 200 self identified as transgender. In fact, we do not have prevalence in young people in our Multidisciplinary Program housed at ucsf we have seen 350 patients with the first 7 years ago and get 8 to 10 re ferrals every year. I would like to show quickly a couple of slides. You can imagine it isnt surprising there is consequences for the youth where the Parent Support or dont support these kids and what you see a study out of toronto comparing negative melthal health out comes and positive out comes for the youth have supportive parents versus unsupportive parents. What we are looking at here, when you see a dark blue bar the kids parent are supportive and light blue not very supportive. Going left to right, depression and suicidal [inaudible] and suicide attemptsism the risk is decreased if the parents are supportive and it is worth pointing out in the farthest bar on the right the parents are not supporting and more than 50 percent of these individuals attempted suicide. With a positive Mental Health out comes. Where and see the dark blue bar it is supportive parents and across in particular for the level and degree of melthal health, self esteem, Life Satisfaction and in every case it is better if the individual has supportive parents. Because of the complexity of the care for the kids and need for support it seems clear a Team Approach is important. About 6 and a half years ago individuals with expertise around the bay area came together with a shared vision of creating a program to meet the diverse needs of transgender youth and this was born the child and adolescent center. This isnt specifically a ucsf program. This is a collaboration between ucsf and Key Community organizations which i outlined here. Gender spectrum is a leading National Advocacy group and we are fortunate they are here in the bay area. You can also see the nclr, i was happy to learn despite the name they play a significant role in dealing with legal issues to better the lives of transjnder individuals. Then we have mind the gap which is a network of Mental Health professions trained in gender issues. Then we have the hospital. The child and adolescent clinic is housed in [inaudible] i would like to introduce my dear colleagues doctor diane [inaudible] associate professor at ucsf and locally, nationally and internationally recognized expert in Child Development and transgender youth. Thank you very much and im just going to walk through how we think in melthal health terms. What we know is what you heard is it is risky for the transgender. We got rid of diagnose jnder identity disorder. The focus is on the distress stemming from the gap from ones assigned sex and their sense of gender. Youth gender distress can reach alarming levels and ill epeat, there is 2 to 3 fold increase risk of depression, anxiety, suicideality and self harm. Primary cause of the distress, negative hostile response to child. Refusal to recognize youth authendic gender and chronic microaggression and [inaudible] ergo transgender pathology lies in the [inaudible] studies show family exceptance leads to increase in positive Mental Health outcomes and rejection decrease. Corollary is melthal health support. Not just families some come for support. Jnding specialist are key to promoting and holding a childs gender health and when we talk about gender health at the clinic we mean the use opportunity to live in the gender feels more real and comfortable. Ability to [inaudible] rejection. There are two opposing models of treatment that exist for jnder non conforming children and we can make or break a childs gender health. We have therapys that change a childs gender. They can break a childs gender health and not legal in california. We have affirmative therapys that we use and they can make and support a childs gender health. We have a problem, we dont have good enough training and we dont have enough money to adequately serve all the children who need to be seen and the result, we have a whole group of kids in San Francisco, bay area and nationally who are at risk without access to good affirmative care. The good news, the gender affirmative care leads to psychological wellbeeling, bufferers against gender trauma and reduction in serious risk factors. I want to say a word about dante. At age 3 announced he was a girl and only could do it at home so we see the first compromise of dantes gender health. By midchildhood we see things are not going so well and showing anxiety and depression but things look up at 13 when dante enters the clinic and gets support. The Insurance Company throws a Monkey Wrench and that makes dante anxious and that is when we put in the legal report. I want to thank you for listening to the Mental Health component and want to introduce you ta[inaudible] and also the senior director at gender spectrum. Before you switch over just a quick question, that was the chart at the beginning used the terms of the differences in outcomes between children with supportive parents versus children with parents who are not supportive and what a profound impact it has on the childs Mental Health and perhaps survival. For children and adolescence who dont have supportive parents, how do they or how can they best Access Services . Those are very good questionsfelt we do it under the umbrella of building gender resilience. We built it in a child and know some children dont have a supportive home so we look else where. Schoolerize a critical components of gender support. Support services and programs and dimensions critical. Kids need to find a place where they are mirrored positively and someone is watching their back so if we cant find it at home we find it else where including a Mental Health profession al who is their mentor and a person who watchs their back and goes to bat and im a optimist. We start with parents who are not supportive and hope to move them towards being supportive. How do you in your experience, i know every child is different, but for a child who has family othome who are unsupportive and perhaps hostile to the childs true gender identity or expression and lets say they get good support at school or through other resources, how does that tend to balance out . Do you find that if a child is getting good support at school or other resources that that can help to partially counter act the lack of support or haasetility at home . I can only imagine what it would be like for especially a young child or adolescents or anyone to be at home for the people charged with caring for you that are unsupportive or hostile towards who you are, do you find there can be at least some sort of compensation there . What i find is there is compensation but they can be growth. What we do is build a fire wall around the child so they know that the pathology lies in the environment, not in them and they deserve the support that every child deserves. In the mean time what i will say is a child can change the family. As the child grows in strength and if somebody is work ing with the parent and family we see movement so the parent are not static, but some parents are move nl and then we make sure we build the fire wall there and make sure there is a alternative form of support when chis why we are here today to make sure those are in place because we see what happens for the children at home when they dont get support but home isnt the only place you can get it. One last question, in terms of children who either are running away from home or being kicked out of their home because of families rejection of their gender identity, how often are you seeing that in San Francisco . We know we have had for many years a problem around the country, around the world with lgbt young people kicked out of their home or running away from home because they just cant take it anymore. How often do you see that in San Francisco . We see it less here than other parts the country but it is here. Im a Family Member of the home within and pro bono children in youth and foster care and a disproportioninate number of youth are those kids that couldnt stay home because they are lgbq. Thank you. Good morning everyone and my name is joel bound and senior director at Organization Called gender spectrum as well as the medical and advocacy director at child and adolescent gender center. Thank you for the opportunity to share information about the wonderful work our clinic is doing on behalf of young poopal people in the bay area. I want to start with dante, who wants to attend school as a girl and needs support in doing so through a gender transition plan, what are the conditions that will make such a plan successful . I want to return supervisor wiener to your question because in the face of unsupportive family and care givers schools can be so critical. Sometimes it is just that one teacher or yard supervisor or secretary who tells that child you matter, where see you, you are authentic and dont have to pretend to be something you are not. That can save that childs looif. Im a former educator and had the experience oof having a child make it because of a caring adult on a School Campus so want to emphasize that role is critical. The other piece i would add is when you think about our center imagine a table with that child and family sitting on the table. The 4 legerize the legal, medical, Mental Health and educational support so when any leg isnt in place of course the table tips over and that is the model that we have here. When it comes to education, gender spectrum has a specific mission around creating particularly gender inclusive environments for all young people and ironically it is the focus on all children that actually creates the conditions for our transgender and gender Expansive Youth to be successful. We know gender impacts every child and San Francisco has been a leader in the creation of gender inclusive spaces for all kids and in so doing supporting transjndser students. The work San Francisco led by kevin and eric as well a a team of educators has been a National Model for ways in which schools can systematically from top to bottom support the needs for transjndser young people. We do see in some cases with the families we work with implementation remains a question based on site knowledge. When there are sites with a strong sonesf understanding about the issues, a strong notion of what needs to be done kids have wonderful cases and in some cases that isnt always the case. I guess what i want to talk about finally is the importance of being intentional in creating the kind of conditions we are talking about. We know that individual educators have to be thinking in 4 different ways inturnly about their own gender, instugzal about the practices in place such as the gender change forums, the interpersonal ability to work with young people around gender and instructional support that needs to be in place. What we know is our transgender student are most successful in school when gender is talked about as it relates to all students because the notion it isnt about certain kids it is about all kids and when young kids have a opportunity to learn about gender as a concept, the experience of the transjnder student suddenly makes sense. There is a schema, if you will, that leads to the understanding of that childs experience and the ability for that child to transition. We are privileged to work in a number of San Francisco schools where this model is in place, where through education with students, through the great support the district policies and other institutional practices we have seen students transition at school such as dante and are it be a positive experience for them but every child in the classroom. Ill conclude by saying ironically creating gender inclusive spaces for transgender student cant focus only on the transjnder students, we have to think of all student for support of gender diversity. Thank you very much. Ill reintroduce [inaudible] child and adolescent gender center and one of the key founders and organizers of the clinics creation, doctor rosenthol. Thank you, joel. I hope you are getting the flavor of the Incredible Team we have and how wonderful it is to go to work every day. I would like to address the needs and problem dante faced when the treatment that is shown to be life saving was denied by insurance companies. We have to start with what we know. What we learned in recent years is gender identity isnt just a psycho social construct. There is evidence biology plays along with environment and culture a clear role. One of the other things we learned is those youth that meet the Mental Health criteria for being transgender at early puberty are likely to be transjnder as adults. There is a very important stoudy published orfb a year ago that confirms and makes clear the impact of affirmative medical care and this is the use of pubetle block rb jz cross sex hormones. This is a class of medications that put puberty on hold and basically give a transjnder child a little more time to explore working with a Multidisciplinary Team issues related to gender identity. We know for someone who truly is transgender the anticipation of going through the wrong puberty can be devastating and leads to medical needs for surgical interventions that could be avoided. [inaudible] the first long term observational study using pubeter blockers and gave extratime putting puberty on hold and all of the kids chose to go to the next step which is receive the sex hormones that matched their affirmed identity. After 18 they had surgery. When you look at the mental helths at the conclusion of the study and compared Mental Health to controls that were healthy young adults, the quality of life and sense of self worth were equivalent but in some cases superior. This gave a tremendous impact and support for the type of work we are doing in the Multidisciplinary Program. These findings and principles are endorsed by every major professional endocrine and Transgender Health society in north america, europe and other parts of the world. All are needs to optimize care and proud to tell you our center chs awarded for the first time funding by the nih a 5 year study to create a National Network with centers in San Francisco, la, chicago and boston to optimize the medical treatment. What you mentioned there is a important point about delaying puberty so that children can figure out what direction they need to go in because once puberty onsets it becomes much harder physically to make the transition. You cant reverse everything with surgery so if you look at the testosterone with the vocal cords once they are elongated that is it. So this treatment, delay of puberty, it is endorsed by major professional societies, can you give me examples . I think it is important for people to understand this is a accepted and endorsed way of making sure that children are able to grow up healthy with their gender there is document from the Endocrine Society which is the principle [inaudible] published in 2009. The document is cosponsored by thepede at rck [inaudible] there is a new version that is about to come out in later this year. Also the [inaudible] also has its own standard of scare that shares the same recommendation. If the puberty delaying therapy is used and the child determines he or she will stay with the gender that was assigned at birth and decide not to transition the therapy ends . These medications, the beauty of the medication is not only do they put puberty on pause and give that window of time but are completly reversible so should someone determine they are not transgender you stop the medication. In this study of 70 individuals that were veryit was a strict study so you dont get into the study unless you are transgender they all went to the next [inaudible] it makes a lot of sense but reversible. We know children in the normal course of things go through puberty at varying ages. Absolutely. One of the limitations despite the impact on our world is they didnt treat anybody under 12 and we know kids go through kids much earlier than that so we so happy the nih recognized the importance of funding a program like this that is focused not on just age but on when puberty begins regardless of age. That will take about 5 years to get that information. Despite that success on the Research Side what happens in the day to day care of these kids . This is where we have the barriers and that is right now the medications all of them are off label, meaning none are approved by the food and drug administration. They are expensive. You can buy a new car for a cost of one years treatment and often these are denied by insurance companies. There are other barrier tooz care, there are few Clinical Programs and lack of training. There is a lot of misunderstanding in the public and among our colleagues and even the model of the Multidisciplinary Care is valuable. That at various dimensionerize not reimburseed. I would like to introduce our legal director. This is asaf orr. He is a transgender Youth Project staff attorney. Thank you very much. So, as doctor rosenthol mentioned im the legal director and work at the staff attorney. I decide to live at my remarks today to Health Insurance discrimination but happy to address any other issues mentioned. I want to give a scope of the issue here. What we have federal state antidiscrimination laws in place to protect transgender people and chipped away at exclusions the barriers still exist. If they dont exclude all care they are low monetary caps on care. There are prerequisites based on the standard of care and when you talk about young people they are still provasive exclusion for folks under 18. Insurance companies are [inaudible] sortf in a position [inaudible] because they cant get policies without exclusions. I want to give a sense of the legal landscape. There are a flb number of laws that protect transgender. On the state level we have the [inaudible] housing act. On the fral fral level we have [inaudible] Affordable Care act and Civil Rights Act and provision for public employers. Reading the list it seems like someone should address this. Unfortunately it is a very loose net so kids fall through. Like we were talking about dante, he fell through because of the cofs care and unable to access it and force today go through puberty inconsistent with gender identity resulting in physical changes and Mental Health effects. I want end with giving the board a sense of at least some things the board can do to help address this issue. Building on the leadership the board has shown around the issue with access to care for transgender adults is insure the Health Insurance policies offered to employees of the city and also healthy sf covers the range of care that transgender youth under 18 may need. That includes the puberty blockers doctor rosenthol talked about and hormone replacement therapy and surgical intervention. Beyond that insureing the San Francisco juvenile Probation Department and family and Children Services have written policies and protocols about how to address the needs of transgender youth in care and custody and pass a ordinance that prohibits the sale of insurance that discriminates transgender youth. Thauchck for your time and happy to answer questions. Thank you very much. I want to thank nclr for as many years i have been involved in the Lgbt Community in San Francisco going back to the 90s long before it was widely even accepted in any way to support the Trans Community and Lgbt Community, nclr wnt well beyond the name and created the transjnder law center so it is a Real National leader and want to say thank you for that. Thank you. Great. I think that concludes our presentations. I want to thank you to staff and particularly dr. Rosenthol for your amazing cutting edge work. I think supervisor yee may have a question. Just curious because we have a report from the School District in terms of breaking down a [inaudible] they found and both of the 300 plus individuals you have seen, does it seem similar to the School Districts . As you know in the private schools which we have a lot of, the ethnicity is different so dont know we have varied ethnicitys. We dont just surfb the city of San Francisco, we get kids and families all over the place. Mostly from Northern California but people come from alaska, florida, utah and egypt. I say the majority are caucasian and well off but see variety of ethnic diversity. Of the ones that areyou would know if the individualerize from San Francisco or not . Yes, we do. Within that subgroup what does it look like . Is it also majority white, majority people that have resources . I would say the answer is yes. One of the unfortunate realties is in order to come to the scene in the Clinical Program you have to have approval of at least one parent so that is something that factors into this. It doesnt predict what the ethnic background will be. I say it is very similar what is presented before among the people that are local residence. Thank you. May we go to Public Comment . Open tupe public common. I believe supervisor wiener has one speaker card. People that want to do Public Comment if folks can line up on that side of the room. Public comment is two minutes. [inaudible] carpenter, but anyone can come on up and speak. Maybe well start with Theresa Sparks as the Department Head as director of Human Rights Commission. Director sparks. Thank you supervisors this is a incredible presentation. We at the Human Rights Commission havent worked with this clinic but worked with transgender helths otucsf at the main fusity. San francisco is leading the world in funding currently for transgender programs. We have a Work Agreement with the city of amsterdam as you may know to work on transjndser and lgbt issues, in fact, we have a delegation going to amster dam this year. This fiscal year San Francisco is supportive of transgender programs beyond anyones wildest ecpectations. San francisco is contributing about 1. 5 Million Dollars to transgender programs in San Francisco. This entails about half going to hiv protection and research and medical needs and Case Management around medical needs primarily adults. The other half goes to several programs, one is 200,000 to lgbt center for employment. 200,000 goes to latina transgender. These are people who are at a intersection of immigration issues, homeless issues, employment issues, language issues, being transgender and being women and also cultural issues in the Latina Community so very very high at risk and appreciate the boards work on this. We have 150,000 for 2 years for Coalition Building to put together a council. That is moving forward very quickly. We also work with transgender and intersex Justice Project working on doing counseling and Case Management within the San Francisco jail system and work ing with the safeers department the old seraph and new placing transgender people taking out of the mens prison which is where they are located and putting them in the womens side for programming and housing. San francisco is the leader in the world for the programs. The missing link in the programs is dealing with transgender youth. Ucsf is a leder in that. Uc system nation wide is a leader in transjndser issues. For the last 5 years i have been on the taskforce on the uc system dealing with lgbt issues and transgender. For the first Time Starting this year and Going Forward all freshman and under graduate applicants for uc will be asked 3 questions, one about gender identity. How do you you identify with your gender and aortis Sexual Orientation. Next year the following year it is all graduates university and graduate students and the following year the questions go on all employment applications and also on all staff and faculty. So, this is information that we never have been able to gather and will gather on several hundred thousand applicants of the uc system. These individual things moving forward are critical to being understand really the dimension of the issue. Unfortunately in San Francisco passed ordinances not allowing to ask these questions in San Francisco so well come to the board asking for a exemption to ask people their jener identity and Sexual Orientation in the aggregate. We wont be able to identify individuals but get information to understand the scope of the issue. Supervisor wiener mentioned homeless youth. Homeless youth anic dotally, [inaudible] young transpeople come ing to San Francisco. Unfortunately we dont have a central spot to enter the system so we are way ahead of everyone else we can take further steps and look to the board to take steps to complete that psychosqul also make San Francisco continue to be the leader in this area throughout the United States. Thank you, director sparks and i do want to note that we are actually getting close to introducing Data Collection legislation to make sure that for various city programs we are tracking in a aggregate way our lgbt population. We are behind on that in our city and so our lgbt asian task force recommended that and decided to go beyond seniors but the entire population. Appreciate your work. One fact you may want to recognize, this year the United States used our tracking stats San Francisco on transhomicide and suicides. There were 43 transhomicide and 90 percent are women of color and 41 recorded transsuicides and 80 percent were caucasian and most caucasians were male. Female to male. We have statistics that are social issues all of which i think ucsf is perfect for research. Moving to Public Comment. Public comment is two minutes. Charles [inaudible] and attorney legal volunteer for some of the work you have seen and also a constituents of supervisor wiener so thank you and the other supervisors. I just want to say 3 quick things about coming to this from the outside which is what i did 5 years a. Go. There is a role for advocacy for transgender people he became involved because he was seeing families and didnt know how to provide the treatment and did the research of other peoples Research Understanding best practice, so his work and clinics work and the work you are asking Public Health to do is researched based advocating for the health of the patient and family. The second thing i want to reinforce is what supervisor wiener also said is this is all most never talking about surgery for people under 18, it is talking about a medical perspective, puberty and hormone and reversible treatments and as you go forward with this work you will see surgery for kids and teens is what is the opposition throws up because it [inaudible] and then the last thing ill say, if you can be at the question and answer sessions at gender spectrum which is National Conference in the bay area, it is so moving to hear parents introduce their families by saying my 9 year old daughter was perceived at birth as a boy. From my perspective when i hear that i say who am i to judge because that isnt a pop ylthz position and not trendy, but when you hear the parents you know it is coming from a deep place. Thank you very much. Thank you. Next speaker. Good morning supervisor, adel [inaudible] director of San Francisco Youth Commission and before joining the staff i was a outreach worker for a lgbtq melthal health and Substance Abuse clinic which is no longer specifically work wg young people. Youth commissioners heard this a few months gow and thank you for your attention to it. Their response should be included in your packets. Among their responses i wanted to highlight was just that in addition to the critical investments dph and dcyh make in service for transjendser youth that are concentrated in the castro and tenderloin commissioners are interested seeing how the city can continue to invest in increasing the competency for services. To that effect im glad to see the School District was in the room because i think they work is critical. Another piece is for a decade and a half or so the city had a Unfunded Mandate in the admin code that requires Youth Service city staff and contractors to be trained in lgbtq competency. Increase City Investments in supporting departments and undertaking the trainings will go a long way increasing competency throughout our Youth Service city services. Absolutely behind director sparks and with supervisor wiener and hopefully this will be the year we can ask the question and gathering data on Sexual Orientation and gender identity throughout the city services. I think that will go a long way addressing the needs transyouth had. Also grand e glad dimensions clinic is here. I know a lot of young people are not able to get service in a trusted environment and many wont access the suvss at all. Im under the impression that the wait list for dimension clinic is closed to seeing what we can do to make the Services Available to young people. Thank you, i appreciate it. Next speaker. Good morning. We also have a memo that we want to hand out. Kwlrks clerk will get it. So, my name is cristina [inaudible] Program Manager for a Leadership Development and school based initiative at lyric and lyric serves transjnder young [inaudible] and that number of climes to about 18 percent for transitional age young people 16 to 24. [inaudible] basic needs support to paid leadership opportunities and [inaudible] we want to highlight 3 pivotal issues we have seen reflected in local and National Data as well as the young people we work with. Long standing high levels of suicideality, one out of three transmiddle school and one out of 5 high school attempt suicide. We also know is a epidemic of violence of transjnder and nearly 100 percent of lyric young people experienced violence inside and out of school. We want to high the hiv infection rate which are higher for young people. Something i want to opponent out as i listened to earlier comments is about the resilience of trans and gender non conforming young people when they are supported. We have 3 recommendations, the first is around enhancing the wellness model to achieve access and afirming access for transpeople at the middle school level. The second is training and [inaudible] Community Based organizations to improve capacity for trans and gender non conforming young people. Lastly, expand ing access to [inaudible] for young people who are 17 and under to reduce infection rates. Thank you very much. Next speaker. Im jed rod riz regs and transgender and 18 and work with lyric. I work with the internships we do with transyouth 14 to 18 so i want to talk about the struggles they are facing. So, a lot of the kids that i work with talk about being bullied and harassed at school. They names are pronounerize invalidated. People dont use their preferred names. They talk about how teachers are misgendering them and use thg wrong name and teachers set the standards. They are the Authority Figure so if they invalidate your identity other student also do that, right and think it is okay to do that. I think it is important we focus on educating everyone in our schools, right . Comprehensive training about supporting trans students for staff and teachers so they can advocate for students. I just want to echo how gender impacts all of us so that is what it is important to make sure transpeople and youth are supported because that is something all of us have a fight in. I want to echo what the work at lyric is important. Transchildren face social isolation so we focus on community which helps combat self harm and keep people from self harming and stuff. So, thanks. Thank you very much. Next speaker. Hi my name is nathan smith and twait year old advocate and ally and someone who benefited from the services. Im here to represent youth who benefited from these services. I came out around 10 and my adopted family had mow resources. This was just when lyric started out and there wasnt much to do. I did have the social support but didnt have systematic support. At lyric i was made aware of the prevalence och the lack of support, scholastic and institution lt support and i was blown away by it. I was privileged to have the connections to Start Talking about the issues for queer youth and i want to say maybe 2009, 2010 by 2012 ab 1856 passed which was something that i was instrumental making happen to foster youth and school work and social settings. This is ov15 years ago and still little progress is made which is why im here because im worried about the future of queer youth. I was a victim of bullying from 10 onward so much so i had to transfer schools because the school was less inclined to deal with someone was gender variant than the fact i was being bullied at school. Im here to advocate to allocate funds for queer youth and say how imparaative it is more than just path logical stuff and surgery and hormone blockers we need all around support and the youth are slipping through the cracks and aging out of the system and need to stop this before it gets really bad. Thank you. Thank you very much. Next speaker. Hello, my name is [inaudible] i too work at lyric. My position is queer educator. Moving to San Francisco was really difficult for me. I moved twice actually. The first time i moved it was hard for me to find resources. I wasnt connected with lyric the first time i moved out here. The first time [inaudible] i kind of like found there is a scarsty and everything was moved around and i didnti wasnt able to go to dimensions because my insurancei had kaiser, i still have kaiser, so im not able to reap the benefits of other trans folk in my community. I kind of like am my own entity but like to have a social community. It is actually hardthe first time i moved out because i wont able to get my prescriptions and it was really difficult and i noticed i didnt fall into the sectors of this as like needing help. I recently found out about getting on [inaudible] when i moved out here and the cost of [inaudible] is high for me and im not able to afford it right now at this time. So, i just noticed that i want the ability to be for every wherein wn who needs it. Also housing, my program that im in is the only Housing Program [inaudible] which is a temporary shelter but the [inaudible] through larkin street is the only resource [inaudible] specifically being lgbt and find it will be hard once i get out of the age range of being 24 then im like, what do i do, so i just want the accessibility to [inaudible] for our needs. Thank you, again. Thank you. Next speaker. Hello, my name is [inaudible] the Program Manager at lyric. I want to thank you for take ing the time to [inaudible] transyouth of color and i want to dive in further on some of the recommendations that cristina made earlier. We are really interested in further investment in San Francisco Unified School Districts Wellness Center initiative. Their model pairing Community Based organizations on site in the Wellness Center and high school demonstrated a cultural relevant standard of care for particularly youth of color. Their data showed the majority of lgbt youth in San Francisco are of color and that is where the resources need to be invested. Our relation is on going. [inaudible] support folks with changing the name and gender marker and attending court along with youth when they go to the hearings. We successfully partnered with supportive parents change thg young folks name and gender markers so a incredible partnership as well as exciting to see families of color are absolutely invested in their young peoples wellness. I also want to reiterate edells points about expanding training and Technical Assistance across city cross sector. Everything organization in San Francisco needs to be able to serve transjnder youth of color. We cant have a few doors for folks to enter and be seen and valued and seen as whole, folks need to be able to go anywhere so what that will look like is the city taking a bold stand and standing in partnership to fund that Technical Assistance. The final point is critical around hiv prevention. [inaudible] in San Francisco is the only clinic under the Community Health programs for youth that is providing access to use under the age of 17 and know Trans Communitys have disproportioninate rates of infection in San Francisco and see it for a opportunity for prevention early on a pair mount any additional Public Comment . Seeing none Public Comment is closed. Thank you for scheduling this and colleagues for listening today. This is a very very important issue and we need to make sure we are doing everything we can to support our transgender and gender non conforming young people at all ages. It is a emerging issue nationally and one that is going to i think require more and more attention so thank everyone who presented today and for all the amazing work that is happening in our city where we continue to lead on so many issues impacting the Lgbt Community and look forward to continue discussion including during the budget process how we can support this work. So, mr. Chair i would request that the Committee File this item. Okay. Thank you supervisor wiener and thank you to all those that came out and all the work you are doing. Presentations like this are incredible and enlightening. With that we entertain a motion to file . Motion by supervisor yee and take without objection. Do we have any other business in front of us . No other business. See everyone at 1 p. M. Mpt. We are adjourned. [meeting adjourned] power its all around us in the sun and the winds and caves waves power that lights our homes while protecting our Natural Resources clean power will provide power to san franciscans how about works right now our power is from pg e from nonrenewable systems that comes over pg e maintained lines with clean power your energy about think generated by caesarean more renewable sources come to our home e. R. Businesses to the pg e lines cl light for our city and our streets illuminating our ideas and values starting in 2016 the San Francisco Public Utilities commission is xhoefl that light with new led with the did i audits for better light for streets and pedestrian and theyre even better for this vitally lasting longer and consuming up to 50 Percent Less Energy upgrading takes thirty minutes remove the old street light and repeat 18 thousand 5 hundred times while our street lights will be improving the clean energy will remain the same every San Francisco street light is powder by 100 percent godfathers hetch hetchy power in one simple word serious as day turns top of the morning well. Top of morning. All right. All right. Elected officials i have a lot here and where are all the supervisors and the Police Department and the police chief and police chief and all the people are part irish the City Attorney and the consul general and there is supervisor oh, farrell what happens to the o on behalf of the mayor, i want welcome this on the underlying the irish flag and the kickoff of that long but wonderful celebration of salesforce it is a few days off; right . And also welcome the fwrand marshall and also the Court Committee for our city i see sow many wonderful places out there that come every year i guess you drink it or use it rich cream youre a day older so thank you all for being here we love underlying the flag the irish leaders and communities that are up here during the gold rush and some of you are still here when our first mayor was born in richard and had a lot of irish mayorss with sheryl we register and gavin newsom doing his job he had another irish baby so i dont know why he named him duchess so you look at around San Francisco and see all the streets named for wonderful Irish Americans that made San Francisco what it is mclaren park and ofarrell street and ongoing so, now youre keeping up the tradition with the police chief and the police and irish and the sheriff he she is part irish and your part irish; right . Yeah. So we honor all of you by underlying our flag in front of our city hall and starting the clock there is a word they use your mayor was named the river river lee it is my great pleasure to introduce our lord mayor, mayor ed lee. Thank you charlotte i want to extend my warm itself welcome to all of you and the elected officials here our deciding tars and supervisors our assessorrecorder came in nice green carmen i have no problem finding my green tie it says when you are going to wear it yelling at me i want to say congratulations to everyone including the labor unions i say mr. Oconnor and some of the labor union it remind me how our city has been built with the history of the our Irish Americans throughout many, many years and this is a time an opportunity not only to celebrate the staifrz but to review what the community has done for this great city over many, many decades that is incredible you look at the history of our city and how people have built this city and make sure that it reflected the diversity and history where people came from i know that consul general will mention things we are reminded about the easter rising centennial or the hundred and 605 anniversary of our parade and efforts the city that is another great history for the 32 celebration of our sister city and again, i want to say thank you to the united Irish Community for leading the efforts and the parade and having the graushd mr. Boim and others that are here today and being part of volunteers that keep our celebrations alive and the history alive over the jim considering the john boyles or the deferring admit our part of our celebrations of the sister city and charlotte said earlier anita and i have a great trip on behalf of the city to celebrate the sister city and treernd things that help our city for example, the first direct flights between San Francisco and dublin e bin gosh what wonderful clapping. and from what i hear it is more successful than we knew that was going to be a groundbreaking thing it is more successful and continue this wonderful flight and it brought kids from other parts the city to help us with technology and help exchanges culture exchanges it has brought trade and more cultural and educations challenges and, of course, through that all were able to have the t kenny come and visit, of course, timing mike hig goes on and several Carbon Monoxides with him and the Cultural Center and talk about the International Significance of those exchanges that is so many things have happened as a result of the the sister city work and the united irish communities i want to say an is eve of our salesforce to have leadership on the board like supervisor farrell leading not only the board celebrations but work with the board and i get to do and use the talent of our Irish American communities to help us building on the wonderful history to also have fun with the things youre going to see the irish dancers and like the pipers who i got to invited to the kickoff like the mayors cup and have a great celebration there those are all wonderful things happening with our Irish American community from building our city, inform celebrating the cultural to having wonderful talent of people help me run it from the Public Safety to the elected officials im proud of the irish history with that, id like to provide the celebrations this morning with a declaration to be given to the city council and to, of course, president of our irish united irish communities first to consul general phillip grant and hereby calory this to be relishing or Irish American friendship in the city of San Francisco consul general. clapping. and to the president s of our united irish societies let me am come up lee yum. clapping. of course, the greatest cast is my irish and, of course, on the eve of salesforce ive got to say aaron go before this is a translation of salesforce, of course, when i first asked about it i had to explain that is not a professional womens soccer cry but salesforce and give it back to charlotte. Thank you, mayor thank you very much top of the morning now i introduce supervisor o farrell. clapping. hes somewhere. Thank you charlotte and mayor ed lee and everyone for being here that is a proud honor to be the mc this irish celebration outside of city hall to carry on the tradition of a supervisor that does it inside of city hall as mentioned over Irish Community has strong roots in San Francisco for generations going back to the gold rush we continue to sustain the city we continue to work in that and be part of the community. And enblaensz but the Cultural Center out in the subject and so many things we had a a community in San Francisco im very much proud to be part of it and have Irish Heritage and proud to spend on year nature with and here to be with the celebration i want to start off by introducing someone with us a number of years a greatest friend phil grant was with us since 1992 prior to the poivent appointment of consul general overviews the spokesperson tore the media residents for the Foreign Ministry for 4 years and in San Francisco in september 30th, 2014, when it overviews sworn if with us a number of years and weve gone through not only ill say the normal course from the Irish Community buses berkley a rock for the community thank you. And want to welcome you clapping. speaking foreign language. good morning and thank you to mayor ed lee and supervisor farrell at the board of supervisors and everyone who has came here first of all, on behalf of myself and the council thank you to the grand mash for this week and the we lost two important people of the staff you know worked for the consulate for years here funnel is here our thoughts and prayers with her family that time of the year is one we encounter a lot of the people the community that passed away and i find it especially touching because the tragedy that enveloped our community in berkley and before talking about the parade and event that is the opportunity i have i want to extend the biggest thank you to all of you i want to name a few people without them and their assistance and coordination our students and their fascinates and everyone when was involved in what happened in berkley on the 16th of june would be difficult i would like to thank Charlotte Schultz her team working closely did miracles to make sure that we could bring our students home together with their families and on a happy day i dont know if there is is a better report in america they couldnt have done more for us thank you to the police chief and the chief of Fire Services thai provided honor as the cove i think so went through the city the chief of the fire service helped us in berkley the police and fire service out of the hearing aids for a week the middle of that trauma im sure none has managed to say of a foreign consulate will arrive on your doorstep with the Immigration Center with a one volunteers their students and families and the counselors i dont i dont think there was a door i had to open for myself or get food for myself i dont have to travel the police and Fire Services in San Francisco did everything so on my and your on behalf of a real appreciative to all of them thank you. clapping. i have a long line of these in my office some to the 1950s 60s you wonder their words but do they mean anything we found out how much they mean there is a lovely festivity photograph on the facebook of one of the mothers that lost her child in the blockage collapse and her cousins what elita and a photograph of them and airport with libya arrived to start her students and the missouris pink to hold open to in leave is each other i want to say thank you to the city of San Francisco to the people of San Francisco and to the wider bay area for holding on the us in a difficult periods the lives of the Irish Community here in the be sure so thank you all. clapping. were 6 weeks away from marking the one hundred anniversary of the declaration of the proclamation and the easter rising and that was a similar event in irish history that changed the relationship on the 0i8d of the ridership and Great Britain and the relationship with the United States and relationships with europe im conscious it means Different Things to different people while the irish know about that the refreshing americans know and most americans with not familiar with was it stood for ive tried to find the colonel why it is important for everybody and our prayed marks that occasion how to ties to the communities here in america and particularly in San Francisco and the word ill use is in justice what caused the men and women of eastern 1916 to stand up in refwhern a minority and they were told to stay home by something compelled them to take to the streets and even as a time the conflict with the worldclass 1 remaining and later on have any rich americans and serving with the American Services what compelled them to act that was in justice a history of centuries of injustice of being third class subjects to some other people and that resonated very much with the irish experience in america coming here to the first Great Republic if you read the words finds proclamation they echo the words finding declaration of independence to find the majority of them spent time the america and closest family ties to America America is the only name mentions specifically the irish declaration of independence thats one reason we mark that occasion authenticity the human injustice when necessary rose up they were not welcomed by the population of dunn dublin the first horrible days of sheilas and killings they were insult and spat on what changed brought the rest of the country to the point of views and again, we come back to injustice it is what we saw happened the immediate aftermath of the arising the xooigsz and the imposition of mash law you go back to that thing theyve stood up to protest we did this we will have to because of the injustice thai had to be responsible for the same hands that led to their dedicate an irish people have had enough injustice the theme of enjustice links us to other people in other parts of word i want to an event with the New York Times talked about an irish at the age of 14 and mentioned 1 about the 5 million irish show up on the shores of american one. 5 million staifrl unwanted no skills having to be accommodated 9 first references had to absorb and wanting to r a part in the American Dream i think today you read the newspapers one. 5 sitting on the doorsteps of europe he trying to escape
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