“Their tactics, what they’re trying to do, they’re just using force. I think they can turn it down a notch, not be so forceful.
They come up and tell us we’re detained right off the bat.
Then they dig into our pockets and put everything on the ground. Then if they find drugs or anything, they take us to jail. We’ll get out in a couple days.
But you know, I think there’s better ways to do it.
A lot of us don’t want to keep getting high.
We are looking for help or housing.”
Anonymous unhoused person residing in 6th street area
On March 25, Mayor Daniel Lurie introduced some details around his plan to reengineer San Francisco’s street response. The model coordinates City departments to deliver one unified street outreach team model focused on geographic areas. The new street teams model combines teams from across seven departments—Police, Fire, Sheriff, Public Works, Public Health, Homelessness and Supportive Housing, and Emergency Management—into a single team that focuses on five specific geographic areas and a citywide unit. The areas are organized according to police districts: Tenderloin/Northern, Mission, Southern/Central, Park/Taraval/Richmond and Bayview/Ingleside. Previously there were nine service-oriented street outreach teams, alongside Police- and Public Works-managed street responses, including service calls made to 311. Under Lurie’s proposal, each team will be led by Department of Emergency Management (DEM) personnel acting as a team conductor, focused on addressing resident complaints. SFPD would lead enforcement with Public Works.
There is good news about this approach along with some bad news. The new operations combine enforcement with social services across the board, which is bad. Mixing every street team with enforcement, and putting DEM at the helm—despite its leadership of the unsuccessful and often trauma-inducing Healthy Streets Operation Center (HSOC)—is not a great choice. However, there is some good stuff in there in terms of coordination between departments that help folks.
The Problem with an Enforcement-Led Response (A really expensive way to exacerbate homelessness)
“That’s the fundamental problem right there: We simply don’t have homes, a place to live…
It’s illegal to sleep in the city now if you don’t have a home or even sit or lie down—and that’s exhausting.”
Policing typically results in move-along orders, citations, confiscation and often destruction of property. A 2020 study found that enforcement-first approaches “systematically limit homeless people’s access to services, housing, and jobs, while damaging their health, safety, and well-being.” Rarely does a police response lead to ending an episode of homelessness, yet millions of dollars are spent on this same response—those millions could be better used to invest in long-term solutions. A 2016 report from the City found that “current enforcement measures are too expensive” and that SFPD had “limited results from enforcing quality-of-life laws against the homeless.” Beyond its ineffectiveness, policing is a punitive and harmful response to homelessness that exacerbates racial inequality. Police encounters often leave those who are unhoused, disabled, and experiencing poverty feeling as if they are unwanted and disposable. Unhoused individuals have repeatedly fallen victim to police violence, such as Luis Góngora Pat, who was fatally shot by SF police on April 7, 2016. National experts have unaminously weighed in that criminalization hurts efforts to address homelessness, from the National Alliance to End Homelessness to the United States Interagency Council on Homelessness.
Where the street response should live
The Lurie Administration proposal tasks DEM with providing services during street response. This department handles emergency response, dispatching fire and police to put out fires, transport accident victims and respond to crimes in a timely manner. It also oversees complaints coming in through the 311 system. DEM is charged with quickly responding to emergencies, but it’s not equipped for ongoing care, engaging people in services and addressing long standing inequities.
Better suited for long-term response are the Department of Homelessness and Supportive Housing (HSH), which oversees services such as shelter and housing, and the Department of Public Health (DPH), which oversees medical and behavioral health treatment. A key to a successful street response—especially when considering the needs of individuals at severe medical risk—is ensuring continuous care, which requires developing trust. A good street response doesn’t just respond in the moment—it works with people over time to identify appropriate placement, address their immediate needs, enroll them in benefits, clear barriers to care and advocate for them. “Over time” is key, because shelter and housing placements rarely become available immediately. Keeping in close touch is crucial so that placement can happen swiftly when a bed opens up. We recommend that DPH collaborates with HSH in overseeing the street response.
What a data driven street response should look like:
We propose the City replace all the current teams plus other street response expenditures. These new teams should be deeply trained and clinically supervised, collaborative, geographic-based, peer-based teams. Furthermore, they should be centered on unhoused people with whom they would collaborate in developing exit plans with clear objectives and measurable outcomes. These teams could be a mix of City employees and contracted out to nonprofit organizations.
Components:
A. Training
A newly designed street response would be made up of extensively trained community members with a support system for troubleshooting and updating strategies. Staff training will deliberately be much more intensive than for a typical street outreach team. Key to the success with Eugene, Oregon’s CAHOOTS program is the 500 hours of field training that staff undergo, along with 20 hours of classroom training and regular follow-up training sessions. For San Francisco, prioritizing hiring those who have lived experience with poverty and homelessness, including Black and Indigenous people of color (BIPOC) and transgender individuals, as well as others with lived experience with homelessness.
B. Collaboration
A newly designed street response team should have deep levels of collaboration with other City entities and providers to ensure that individuals receive the care they need. For example, if medical situations arise, the team should collaborate with street medicine for urgent street-based care and follow-up. For individuals with substance use disorders, it should collaborate with the behavioral health center for placement, or the Dore Alley Urgent Care Clinic for crisis placement. It could also address legal needs, such as assistance with benefits in collaboration with Bay Area Legal Aid or the Homeless Advocacy Project. The team should develop a plan for each individual with the collaboration of relevant agencies.
C. Peer-Based Teams
We propose two-person teams made up of people who reflect the community they are working in and have lived experience with poverty and homelessness. Teams would provide services including first aid and non-emergency medical services, substance use/addiction referrals or resources, psychiatric hospital transportation services, de-escalation intervention and interpersonal conflict resolution, street counseling and mental wellness referrals or resources, suicide prevention, housing referrals or other resources.
Geographic areas would be divided up, and different organizations could be responsible for a particular geographic area to ensure cultural competency. The team would be dispatched to low priority 311/911 calls in their geographic area, but would also be responsible for caring for all unhoused people in their assigned zone, regardless of whether the call originated from a 311/911 call, or if the unhoused person is living in a tent. This more comprehensive approach would increase equity and move away from the piecemeal approach that a complaint driven approach represents.
D. Clinical Supervision
The peer-based teams would receive clinical supervision both on site and after reviewing incidents in the field. A clinical supervisor would spend time with each team, observing and engaging in dialogue with the team, reflecting on specific cases and giving technical advice on what worked well and which other tools and approaches the team might try. The clinicians would coach peers on motivational interviewing and assertive outreach, among other skills. Lessons learned in the field would be brought to training as examples of approaches that work and don’t work.
E. Geographic areas
Impoverished neighborhoods in San Francisco would be divided up and a two-person team assigned to that area. In areas with high density of unhoused individuals, the team would be assigned fewer blocks. This would allow for cultural competency in specific subpopulations. For example, teams assigned to Castro and Polk Gulch should include members of the LGBTQ+ community, and Bayview teams should be made up of members of the Black community, while a Mission team would have a Spanish-speaking, culturally Latinx makeup.
F. Expected outcomes and accountability (including ongoing care)
The teams would be expected to track placements for each unhoused person and have a plan in their geographic area that is co-designed by the unhoused person. This plan would take into consideration any family members—related or street-based—they rely on and would like to stay in community with. It would also look at addressing potential barriers, appropriate placements, necessary steps and timeline of securing placements and securing needed documentation to complete the paperwork. A key ingredient of successful data-driven models is respect for the autonomy of the unhoused individuals. This also has the parallel benefit of addressing concerns of local businesses and housed community members who are looking for successful exits from the streets, not just shuffling folks from corner to corner.
G. Budget
There are currently multiple teams with multi-million dollar budgets. For example, the Homeless Emergency Assistance Resource Team is budgeted for $3 million, while the Street Crisis Response Team has a $13.4 million budget, and the Street Wellness Response Team has a $9.6 million budget. Meanwhile, HSOC’s budget is estimated at about $20 million. This allows plenty of room for a new pilot project without expending new resources. In fact, this model would save unnecessary police deployment, lessening the need for police overtime.
