San Francisco County Grand Jury
• 2015-2016
San Francisco Homeless Health & Housing a Crisis Unfolding on Our Streets June 2016 Photo: Eric Risberg/Associated
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 6 findings
F1
Homeless Outreach Team (HOT) should serve as first responder to non-violent incidents involving the homeless. A coordinated intake system is necessary - We heard from many sources of the need for a coordinated intake system. We believe that an integrated, standardized system containing health, housing and police information on the homeless should be available to all service providers to assist them in providing needed homeless services. Although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) restricts the sharing of some health data, this restriction can be waived with permission from the client. A rich set of data available to all providers identifying and coordinating services is needed. Meaningful outcome data should be developed and monitored - Tracking outcome results at the individual level is key to determining program success. However, this appears not to be a priority among homeless service organizations except in federal grants from the US Department of Housing and Urban Development (HUD). We also found that the monitoring of this data by the Controller's department helped the Navigation Center continually improve by measuring client success and failure. Supportive housing and a shared distribution system are needed - We believe that supportive housing with ease of access is needed to move the homeless from the street to a more humane living situation. We found that there is a need for a single housing application system where case managers and housing providers can be properly matched. This would be a common shared distribution system for low income and supportive housing. Realizing that there is insufficient very low income housing available and that San Francisco Homeless Health and Housing tents on city sidewalks are both illegal and a health hazard, we recommend an intensive effort to put very low income housing in place.
Related Recommendations (1)
R1
Homeless Outreach Team (HOT) should serve as first responder to non-violent incidents involving the homeless. A coordinated intake system is necessary - We heard from many sources of the need for a coordinated intake system. We believe that an integrated, standardized system containing health, housing and police information on the homeless should be available to all service providers to assist them in providing needed homeless services. Although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) restricts the sharing of some health data, this restriction can be waived with permission from the client. A rich set of data available to all providers identifying and coordinating services is needed. Meaningful outcome data should be developed and monitored - Tracking outcome results at the individual level is key to determining program success. However, this appears not to be a priority among homeless service organizations except in federal grants from the US Department of Housing and Urban Development (HUD). We also found that the monitoring of this data by the Controller's department helped the Navigation Center continually improve by measuring client success and failure. Supportive housing and a shared distribution system are needed - We believe that supportive housing with ease of access is needed to move the homeless from the street to a more humane living situation. We found that there is a need for a single housing application system where case managers and housing providers can be properly matched. This would be a common shared distribution system for low income and supportive housing. Realizing that there is insufficient very low income housing available and that San Francisco Homeless Health and Housing tents on city sidewalks are both illegal and a health hazard, we recommend an intensive effort to put very low income housing in place.
F2
A helpful website is needed - We found no comprehensive, helpful source for reaching the City's homeless services. We hope that with a greater understanding of how we arrived at the homeless situation we find ourselves in today, we can support a view that we need to help and not blame. A strong commitment to strengthening existing programs will enable the City to provide housing and/or housing with services for the citizens who are unable to provide for themselves. San Francisco Homeless Health and Housing OBJECTIVES The overall objective of this investigation is to evaluate the efficiency and effectiveness of the City's program to eliminate homelessness by examining the inter-agency management provided by the City and examining whether the goals could be better coordinated to result in more beneficial outcomes. These agencies include:
Related Recommendations (1)
R2
A helpful website is needed - We found no comprehensive, helpful source for reaching the City's homeless services. We hope that with a greater understanding of how we arrived at the homeless situation we find ourselves in today, we can support a view that we need to help and not blame. A strong commitment to strengthening existing programs will enable the City to provide housing and/or housing with services for the citizens who are unable to provide for themselves. San Francisco Homeless Health and Housing OBJECTIVES The overall objective of this investigation is to evaluate the efficiency and effectiveness of the City's program to eliminate homelessness by examining the inter-agency management provided by the City and examining whether the goals could be better coordinated to result in more beneficial outcomes. These agencies include:
F3
SF Health Services Authority (SF-HSA)
Related Recommendations (1)
R3
SF Health Services Authority (SF-HSA)
F4
SF Department of Public Health (SF-DPH)
Related Recommendations (1)
R4
SF Department of Public Health (SF-DPH)
F5
US Housing and Urban Development (US-HUD)
Related Recommendations (1)
R5
US Housing and Urban Development (US-HUD)
F6
The Mayor's Office of Housing, Opportunity, Partnership and Engagement (HOPE) First Responders We sought to understand which city services are the first to respond to calls about homeless issues and whether the response could be improved. Data Collection and Data Sharing Knowing that multiple agencies, using their own databases, serve the homeless, we sought to understand whether there were negative issues arising from lack of database coordination. Outcome Requirements and Monitoring Realizing that funding is distributed to nonprofit agencies by SF-HSA, SF-DPH and US-HUD, we wanted to understand contract requirements and contract monitoring across the funding agencies to see if there was consistency and if outcomes were effectively monitored. Housing Learning that "Housing First" is a City concept with an objective matching its name, we wanted to know if there were issues in availability of housing and how that affected the programs that are designed to transition clients into supportive housing. SF311.org Knowing that computer use is an excellent way to get information and help, we wanted to know if connecting to homeless services on our SF311.org website was an easy task. San Francisco Homeless Health and Housing SCOPE AND METHODOLOGY We interviewed previously homeless residents, as well as those who provide services to them, to understand why, with all the resources aimed at "solving" "homelessness" in San Francisco, little progress has been made at reducing this population. We examined the outcome measures of several homeless service programs funded or controlled by the City and compared them to the federal requirements for outcome monitoring. When we started this investigation in September 2015, we were impressed with the number of separate City departments providing services to the homeless. As visits and interviews continued, we searched for common practices, information portals and shared tools. We also looked for indications of resource shortages. We wondered if the various City agencies serving the homeless had a good understanding into their client's' situation and predicament. We also asked who was in charge. We apparently were not alone in our questioning; during our investigation our Mayor announced the formation of a new department: the Department of Homelessness and Supportive Housing (DHSH). We interviewed managers working for the Human Service Agency (HSA) and Department of Public Health (DPH). We attended meetings of the Local Homeless Coordinating Board (LHCB) as well as meetings of the San Francisco Interagency Committee on Homelessness (SFICH). We visited the new shelter called The Navigation Center at 1950 Mission, as well as the Behavioral Health Access Center (BHAC) at 1380 Howard and the HSA County Adult Assistance Program (CAAP) building at 9th and Mission. We met with "311" staff and performed our own web searches. San Francisco Homeless Health and Housing
Related Recommendations (1)
R6
The Mayor's Office of Housing, Opportunity, Partnership and Engagement (HOPE) First Responders We sought to understand which city services are the first to respond to calls about homeless issues and whether the response could be improved. Data Collection and Data Sharing Knowing that multiple agencies, using their own databases, serve the homeless, we sought to understand whether there were negative issues arising from lack of database coordination. Outcome Requirements and Monitoring Realizing that funding is distributed to nonprofit agencies by SF-HSA, SF-DPH and US-HUD, we wanted to understand contract requirements and contract monitoring across the funding agencies to see if there was consistency and if outcomes were effectively monitored. Housing Learning that "Housing First" is a City concept with an objective matching its name, we wanted to know if there were issues in availability of housing and how that affected the programs that are designed to transition clients into supportive housing. SF311.org Knowing that computer use is an excellent way to get information and help, we wanted to know if connecting to homeless services on our SF311.org website was an easy task. San Francisco Homeless Health and Housing SCOPE AND
Conclusions 2
-
CL1Police Resource Decisions In the districts with the highest rate of homeless residents (6, 9, 10), there is also the highest crime rate as shown in Figure 3 below. We learned from interviews with police captains that with limited police resources, decisions need to be made about where to send the resources. Dealing with one homeless individual may take hours. If the individual is considered a danger to themselves or others (51506), the police may spend hours waiting for the person to be placed on a 72 hour hold. We learned from interviews with homeless providers that handing out tickets to homeless individuals does not help anyone. The latest twist we learned is that the credit rating of the homeless person will be negatively affected if tickets are not paid. The irony of that is obvious. ^6 Welfare and Institutions Code - WIC DIVISION 5. COMMUNITY MENTAL HEALTH SERVICES [5000 - 5912] http://leginfo.legislature.ca.gov/faces/codes displaySection.xhtml?lawCode=WIC§ionNum=5150 San Francisco Homeless Health and Housing Distribution of 400 Shootings in 2012 by Supervisorial District Distribution of 3,772 Robberies in 2012 by Supervisorial District NA 11 NA 10 11 Supervisorial Districts 9 10 Supervisorial Districts 8 9 7 8 211 6 7 5 1505 6 4 5 333 3 4 3 1 118 50 150 200 100 n Shooting Incidents 500 1000 1500 2000 (Includes Shootings with No Victims, Non-Fatal Shootings, Robbery Incidents and Fatal Shootings) Source: San Francisco Police Department Crime Analysis Unit Figure 3: Charts of Shootings and Robberies by district from 2012
-
CL2During the time we have been investigating the homeless problem in San Francisco, changes have begun to take place. The highest profile change is the creation of The Department of Homelessness and Supportive Housing (DHSH). Just as important is the opening of the Navigation Center, a transition center attempting to move chronically homeless from the street to some form of housing. We have made some recommendations that we feel will have significant impact on improving the existing conditions and should be implemented regardless of the agencies and services reorganizing into DHSH. The jury is thankful for all the help we received from City departments, non-profit agencies and formerly homeless clients as we tried to understand why the homeless problem appears to be more pronounced. If all the City's services and grantmaking intended to serve the homeless population are unified within DHSH, that unit would be well positioned to correct the problems that have resulted from the attempts to address homelessness in multiple organizations. If we believe that our community needs to support people who have not been able to find work, or are not able to work, and who have not been able to find housing, we need to continue to improve the ways we provide support. Some of the improvements this jury recommends are organizational in nature, related to communication and data sharing. Others ask the City to look at solving the problem in a different way - focus on intake, triage and outcome. In order to be successful, there needs to be housing. This could be supportive housing, rental supplement housing, or housing in programs addressing addiction or mental illness. Programs like the Navigation Center require some sort of housing to be available after the client leaves the center. Finally, we are very concerned about the City's acceptance of sidewalk camping during the day. This is a health and safety issue that must be corrected. There is no simple solution, but we feel our recommendations, if followed, will help. San Francisco Homeless Health and Housing REQUEST FOR RESPONSES