In San Francisco, as in other cities, we count our homeless population during a one-night blitz every other year, the biennial “point-in-time” count conducted by hundreds of volunteers who fan out across town. Like so much about homelessness in San Francisco, this year’s count was controversial.
By one measure, the tally of people experiencing homelessness was up 17 percent, just past 8,000. By a different measure — one the city has used on every count until this year — it was a 30 percent increase to about 9,700. By any measure, it’s not progress. But progress is what San Francisco’s new data-driven homeless services system is supposed to deliver, by assessing people’s needs, helping them get to food, shelter, health care, counseling, and job training and tracking them so they don’t disappear back into the streets.
Two years ago, the mayor’s new point person on homelessness, Jeff Kositsky, revealed his plan for this new, efficient system — and had a slide deck to illustrate it. His Department of Homelessness and Supportive Housing (HSH) would set up a network of “coordinated entry” points around the city where trained “navigators” would interview people coming in off the street and prioritize their cases.
The first entry point opened in 2017. But the big techie moment took place in 2018, when the city flipped the switch on the back end, as they say in Silicon Valley: A single database dubbed the Online Navigation and Entry (ONE) System to gather information about homeless clients and make it available to nonprofit groups, like Compass Family Services or Homeless Youth Advocates, or city agencies like the Department of Public Health.
Enthusiasm was soon muted, however, by the higher numbers in the 2019 point-in-time count. Indeed, HSH has been a consistent target for dissatisfied officials and advocates. Supervisor Matt Haney has pushed for an oversight commission; Mayor London Breed fought it, saying it would bog down HSH’s operations. (Haney’s measure may be resurrected for the March 2020 ballot.) And advocates like the Homeless Emergency Service Providers Association have complained that coordinated entry unfairly rations services.
A new, unsettling number has emerged. The New York Times reported this week that more than 17,000 people sought some kind of health or housing-related service through city agencies in the fiscal year 2018–2019, according to a database housed at the Department of Public Health. Whether that number, or something close to it, is a more accurate count than the point-in-time exercise, isn’t clear. “It is a measure of people who were homeless when they received services over the course of the year. Not all of them were homeless all year,” Department of Public Health spokesperson Rachel Kagan tells The Frisc. She emphasizes that the DPH database is not a tracking system; a person could be counted as homeless in February, receive housing in March, and not be subtracted from the total. But it underscores the urgency of coordinating services and keeping tabs on the people who use them, which the ONE System is meant to do.
Behind the grim numbers and complaints, Kositsky says there has been progress. He points to more than 8,000 people assessed, as of last count, as one measure of success. Youth homelessness went down per the 2019 point-in-time count, and advocates give good marks to the youth-focused part of the program, which started about six months ago.
The system is necessary, says Kositsky, but there’s a lot of catching up to do, as he admitted at a recent public meeting: “San Francisco is ten years late getting involved in coordinated entry.”
Bottlenecks and other problems
On any given night in San Francisco, there are more than 1,000 adults on a waiting list for shelter beds. The city’s homelessness crisis is overwhelming the adult portion of the coordinated entry system, which frustrates people like Jennifer Friedenbach, executive director of the Coalition on Homelessness.
She points out it’s been two years since Kositsky began his slide-show presentations, and there are still only two entry points for single adults: one in the Bayview that’s open for 4 hours each weekday, and another in the Mission open 33 hours a week. For Friedenbach, the part-time hours at each location add up “basically [to] one centralized place for assessment,” she says. “There’s only one door, and you can only fit so many people through that one door.”
Kositsky says a new coordinated entry point for adults is set to open in January on Turk Street in the Tenderloin. He also notes that members of the city’s Homeless Outreach Team (HOT), serve as mobile entry points as they walk neighborhood beats, do on-the-spot assessments, and try to nudge people into shelter and services.
Perhaps the biggest positive is stress reduction for clients who ‘don’t have to constantly [repeat] their story’ and relive their trauma.
Megan Geary, Compass Family Services
Once they’re through the door of coordinated entry, residents start with a face-to-face interview with a staff member from one of the agencies tapped by HSH. It’s a standard practice in cities across the country including Chicago, Seattle, Los Angeles and, closer to home, Berkeley. The interviewer puts each person’s information into a profile that might include potential mental illness, substance abuse, and domestic abuse. The profile is shared with city departments and non-profits so officials can track the person and know what services have worked — and not worked. The idea is to take what used to be a Rube Goldberg-esque contraption of duplicated effort, wasted resources, and people slipping through the cracks, and replace it with a centralized system that filters people to the most appropriate services.
Does the “after” picture above match what’s really happening? Not exactly.
For example, it’s not always obvious which channel an unsheltered person should enter. Someone could fall into all three categories — single adults, families, and transition-age youth — at once. “It really depends on the resources they’re looking for and what their current presentation is to determine which path they could take,” said Laura Jessup, HSH coordinated entry policy analyst, at a meeting of the Adult and Family CE/ONE System Committee in October.
Determining who is and is not considered homeless has been a sticking point, but recent rule changes seem to address at least two major complaints. Until recently, women early in pregnancy were grouped with single adults, which meant waiting in a long queue for a shelter bed. But the changes posted earlier this month now give all pregnant women access to Navigation Centers and all shelters.
Families that are doubled up in housing or living in SROs, leaving small children with little space to play and adolescents without privacy or quiet, were previously not considered homeless nor eligible for services. But the rule changes now give these families the chance for coordinated-entry assessments and access to “problem-solving services,” according to an HSH spokesperson.
[This section has been corrected to reflect the updated rules.]
‘What makes the points?‘
The coordinated entry interview is supposed to be triage, like an emergency room where the most needy are helped most quickly. A woman with young children fleeing an abusive partner might receive higher priority than a homeless family with no domestic violence issue, for instance.
Not everyone is happy about how the triage is working. At the October meeting of the Adult and Family CE/ONE System Committee, one commenter said he was shocked that a woman in a wheelchair, living on the streets for many years, went through an assessment but did not receive housing.
We’re trying to change the way business has been done for the last 20 years. We used to be a nonprofit-centered city. We need a client-centered system.
HSH director Jeff Kositsky
Jessup, the HSH coordinated entry analyst, expressed sympathy and conceded that rationing shelter and services is unavoidable, for now, “because we don’t have the resources to house everyone who meets the criteria.”
The commenter, still frustrated, wanted to know how the woman in the wheelchair’s score was determined: “What makes the points?” Turns out, that’s a secret. Even the organizations at the front lines of coordinated entry don’t know how the scoring works, and they’re not supposed to, says Kositsky. “We want to make sure we’re getting an accurate picture, and we don’t want case managers to game the system to get their people to the top of the list. It’s a best practice.”
Kositsky, a former nonprofit case manager himself, is adamant that the organizations conducting entry interviews must use the same set of questions; a client should get the same score, no matter the interviewer. (A score is not destiny. People can be reassessed every six months, or sooner in the wake of a life-changing event.)
The standardization is meeting some resistance. Homeless residents can fall through the cracks, according to service providers who conduct entry interviews, because they don’t have enough flexibility to tailor interview questions to the situation. “Compass and Catholic Charities”— the groups running entry points for families — “each has their own philosophies for working with families, and we have different scopes of services,” Compass’s Geary explains. “There are questions we might ask that Catholic Charities might not ask.”
Inherent in these complaints is a tension between nonprofits who specialize in a subset of the homeless population, and the city, which has to serve all homeless residents, notes Kositsky. “We’re trying to change the way business has been done for the last 20 years. We’re changing the culture amongst case managers. We used to be a nonprofit-centered city. We need a client-centered system.”
There are also rules. As part of the mandate of coordinated entry, for which San Francisco receives federal and state money, the city and participating nonprofits have to follow laws, including the Fair Housing Act, the Americans with Disabilities Act, and HUD’s equal access rule.
“Is the system perfect? No fricking way,” says Kositsky, acknowledging that some people who deserve housing won’t get it: “We need to do a better job training and educating case managers on what to do for folks that aren’t eligible.”
What’s working so far
While the adult entry system faces a bottleneck, the youth system is off to a better start. Last April, six agencies opened their doors to coordinated entry, meant to mirror much of the diversity among homeless young people: Homeless Youth Advocates, Huckleberry Youth Health Center, Larkin Street Engagement and Community Center, 3rd Street Youth Center and Clinic, The SF LBGT Center, and LYRIC.
Kenn Sutto, outreach coordinator with Homeless Youth Advocates, says young people can go to the place where they’re most comfortable. Many are on the streets due to problems they’ve had with their families and the adults who head them. “There’s always friction here — youth are skeptical of city authorities and service providers,” Sutto says. “Trust takes time to build, and they’re asked very intense questions, so we need to provide a dynamic response” with multiple entry points.
Under the ONE System, HYA has helped their clients with grocery subsidies and referrals to supportive housing and jobs programs, says Sutto, but he sees room for improvement getting LGBTQ youth into the system. They comprised nearly 50 percent of the young people in the recent PIT count. Sutto is hopeful that LYRIC and LBGT Center will help make inroads.
Perhaps the biggest positive of the city’s new system is reduction in stress among homeless residents, says Compass’s Geary. Clients have experienced generational homelessness, childhood sexual abuse, and domestic violence. “Once all the information is gathered, it lives there in the system, so they don’t have to constantly [repeat] their story” and relive their trauma.
A better measure?
At a recent meeting of an advisory board that oversees San Francisco’s homelessness services, it was clear how many complicated moving parts make up the landscape. On the busy agenda, officials updated the committee on the controversial Embarcadero Navigation Center, slated to open in late December or early January. Officials also discussed Mayor Breed’s shelter bed initiative, which they said has added 366 beds, with 424 due next year. (In 2018, she said her goal was 1,000 new beds by the end of 2020.)
But the board’s co-chair Del Seymour wanted to know one thing most of all: How would all these efforts help change the point-in-time count by the end of 2020? Was the city doing all it could to get homeless residents off the streets?
Focusing on the fluctuations of the point-in-time count, however, is not necessarily the best way to take the measure of the second question, says Joshua Bamberger, associate director of the Benioff Homelessness and Housing Initiative at UCSF. The biennial count — required by the federal Department of Housing and Urban Development as a condition for receiving federal dollars — is regarded by many experts to be an undercount. It’s done in the dead of winter on a single early morning in San Francisco, just as it happens across the country.
Bamberger suggests a longer-term measure instead: the number of people who move from coordinated entry to supportive housing. “Every time you move someone into permanent supportive housing, that’s the ending of a homeless episode,” says Bamberger. (The UCSF center where he works just started with a $30 million gift from Marc and Lynn Benioff.)
“We know that between 85 and 90 percent of people offered housing stay in housing for at least two years,” he says. “So permanent supportive housing is the best homelessness remedy.”
But that remedy is in short supply for everyone, not just those experiencing homelessness. Until the city — and the Bay Area, and the state — decide to build a lot more housing, rationing is what we will have, and we will need a system to make it as fair as possible. Coordinated entry is not perfect, but it’s a start. Doing nothing, or dithering to come up with perfect, is not an option.