By Emily Nonko
January 27, 2020 —
Early into the tenure of Mayor London Breed, who was elected in San Francisco in the summer of 2018, she began unannounced inspections of neighborhoods. She was making visible a campaign promise to address homelessness. Tents on sidewalks, encampments in parks — none of this is acceptable, she declared, and neither are the scattered, redundant, and ineffective civic programs addressing the issue.
This past September, San Francisco announced a targeted and ambitious plan to confront a seemingly intractable truth of the homelessness crisis — people experiencing homelessness are often not just dealing with a lack of housing. Other factors, many of them related to mental health, come into play. Based on this insight, the city created a multi-agency pilot focusing on about 4,000 people that will coordinate housing and healthcare for individuals experiencing homelessness and suffering from mental illness and substance-use disorders. At the same time, the city will increase access to behavioral health services, with expanded hours at the city’s Behavioral Health Access Center.
San Francisco’s approach exemplifies what civic leaders are waking up to: The homelessness crisis demands coordination among numerous city agencies, nonprofit and housing providers, and public entities, such as hospitals, that don’t typically coordinate with one another. Perhaps nowhere is the need for coordination more urgent than in California, which has a staggering number of homeless people compared with the rest of the country. According to federal data, its homeless population in 2018 was almost 130,000, nearly a quarter of the national total.
“Homelessness is a problem that touches almost every aspect of what a city does,” said Sharon Meron, a former FUSE fellow who helped develop a new approach to addressing homelessness in Long Beach, California. Beyond police departments, emergency services, and criminal-justice systems, this crisis affects schools, libraries, parks, community centers — places where people with no place to call home, comprised of a range of demographics, from children to the elderly, spend their days.
A city’s homelessness crisis doesn’t solely fall under the “Department of Homeless Services.” In San Francisco, Los Angeles, and Long Beach, government agencies are taking an active approach to creating a culture of collaboration that extends into the private sector. These are the insights they’ve learned.
Cross-Agency Collaboration Is Imperative
In San Francisco, as part of its participation in California’s Whole Person Care (WPC) program, cross-departmental staff among medical and behavioral health and social service agencies have been meeting regularly to address urgent issues around homelessness. The state program, which San Francisco has helped pilot along with other cities, allocates funding to counties and health authorities for coordinated, human-centered treatment for homeless people who regularly use health and social services but continue to have poor outcomes.
These meetings have identified a major gap. “All these agencies, then departments within the agencies, have their own process for prioritizing clients into their services,” said Erica Medina Stanulis, who worked on the San Francisco pilot as a FUSE executive fellow. “What that does is allow the client to fall through the cracks.”
Though it took a great deal of time and effort to coordinate, the agencies have since collaborated on creating a shared methodology for prioritizing services for the most vulnerable subpopulations of adults experiencing homelessness.
In Long Beach, a monthly inter-agency meeting brings together city departments impacted by homelessness. “It’s a best practice Long Beach has that other cities should look at,” Meron said. It gives different departments the opportunity to cooperate on ensuring that city regulations are properly enforced, while also making sure that people’s civil rights are protected and respected.
As part of its HUD-funded infrastructure, the city also runs a Continuum of Care program that brings together nonprofits focused on homelessness, including city agencies, shelter providers, rehab centers, and emergency services. A new strategy calls for expanding this group to include additional stakeholders, such as housing developers, hospitals, and city departments that deal with housing.
The program runs a number of working groups, including a Discharge Planning group. The collaboration helped identify gaps in how homeless service teams, shelters, rehab centers, hospitals, and police services operate. “There were different ways of operating that did not mesh with each other,” Meron said. The group realized, for example, that a problem existed in how services are provided to homeless people who are discharged from hospitals. “When you discharge from a hospital, it’s usually at night,” Meron said, “but shelter beds typically aren’t available until the morning.”
In response, Meron helped facilitate a city-run discharge collaborative that works closely with hospitals and community partners to assist homeless patients with gaining access to housing opportunities before they are released.
Nail Down a Clearly Defined Vision and Goals
Defining an agreed-upon vision, along with an understanding of why that vision matters, is key to achieving outcomes. But Stanulis cautions against becoming too lofty, such as, “We’re going to be the best healthcare service agency.” Such a broad vision tends to be forgotten, because there’s no clear way to achieve it. She also advises against becoming too focused on day-to-day, in-the-weeds responsibilities, such as how many people to provide services to in a week, because it discourages creative, ambitious thinking.
An actionable vision is aspirational and backed by clear language, Stanulis said. “We want to be the best agency by reducing the barriers of entry and improving the client experience so they don’t fall through the cracks.” This type of vision goes beyond motivation. “It allows for diversity in thinking and innovation,” she said, “and the space to have transparent conversations on why we haven’t gotten there.”
On any given night in Los Angeles, 36,000 people are experiencing homelessness. Include the entire county, and that number nearly doubles. This challenging reality pushed the city of Los Angeles to undertake the behemoth task of developing a Comprehensive Homeless Strategy. The report outlines short, medium, and long-term approaches to addressing homelessness, including how responsibilities can be shared.
Identifying a clear set of goals was crucial to executing the 300+ page report. The team tasked with writing it had to determine where competing goals had been set in the past, according to FUSE alum Geoff Thompson, lead author of the report.
What they found was a big disconnect between the city and county of Los Angeles. “The city and county often did not take a complementary approach toward homelessness,” Thompson said. “They would work in isolation or in adversarial ways at times.”
To align goals, Thompson and his team worked closely with county staff, which was simultaneously developing its own homelessness report. Advanced copies of each report were exchanged between city and county officials to review. “This exchange allowed an opportunity for the reports to reference one another and complement strategies and funding in a way that had not previously been done,” Thompson said. “For most strategies, if there’s some sort of equivalent on the county side, we referenced it.”
The city report also clarified roles across the city, county, the L.A. Homeless Services Authority, and the nonprofit community — and outlined the responsibilities of each. “The final report is structured into ten parts, and at the end of most sections there are literally strategies you could rip out and use to impact or improve homelessness,” Thompson said. “We built those strategies so that the report wouldn’t sit on the shelf. It had an action plan.”
Break Down Walls to Build Trust
Taking on the homelessness issue has been a decades-long challenge in San Francisco. The Whole Person Care program is not the city’s first attempt at centralizing treatment, so those who were asked to participate were skeptical. “There was a mindset of, ‘Here we go again,’” Stanulis said. “They had tried this before. We needed tools to show there is a mindset shift happening.”
Encouraging honest, transparent communication can go a long way in building trust. But given the varying priorities, strategies, and workplace cultures of the agencies and sectors affected by homelessness, this can be a significant uphill battle. “A lot of the time, when you’re in an organization and have worked in silos too long, you cut yourself off from the inter-dependency that does exist between agencies and departments,” Stanulis said. “There’s a bit of a guard up.”
To break this down, Stanulis created a series of workshops that brought together stakeholders from traditionally siloed agencies. The sessions provided a space where participants could feel safe to express their beliefs, needs, and feelings behind their work, while setting a project vision and defining the focus of a pilot for shared interagency prioritization.
To signal change, Stanulis also included a “pulse survey,” collected, tallied, and presented both at the beginning and ending of the workshop. The honest reflections showed the group’s hesitancy about coming to the workshop, as well as their change in attitude with positive reactions to participating in a collaborative, goal-oriented exercise. At the end of each session, participants also presented output from the day. “This helps drive accountability,” Stanulis said.
The bureaucratic environment for planning around homelessness is usually polished, Stanulis said. But presenting transparent, nondoctored feedback — rather than a formal report — encouraged even more opportunities for collaboration. “It created a conversation between participants to review the output and suggest corrections,” she said. “That doesn’t happen when you analyze something in a silo, polish it, and present it.”
Valuing real-time feedback, such as through pulse surveys, creates a sense of vulnerability within the group, said Stanulis, and affirms to people that their honest opinions matter. Using open feedback to co-create solutions and goals also changes people’s thinking from, “Here we go again,” to, “We’re all in this together.”
Share Progress with the Community
City residents who see their neighbors living and struggling with homelessness don’t always understand the layers of complexity causing the crisis and the collaborative commitment it will take to eradicate it. As cities work to coordinate care in innovative ways, they need to share results with the greater public to garner support, said Thompson. It is constituents, ultimately, who hold much of the voting power to increase funding for services.
After the release of L.A.’s comprehensive report, City Council approved a $120 million increase to its homelessness budget and voters overwhelmingly approved Proposition HHH, a $1.2 billion bond to more than triple the city’s annual production of supportive housing and help build approximately 10,000 units for homeless residents.
“The homeless issue will take years and years to address,” Thompson said. “It’s a really long road ahead for us. There will never be a silver bullet — it requires spending, and it requires thoughtful services. But where we’ve seen the right investments made, we’ve seen results.”