Behavioral Health Services for People Experiencing Homelessness San Francisco Health Commission Community and Public Health Committee, April 16, 2019
Patient Story 2 San Francisco Health Network
Overview • Over 13,000 individuals experiencing homelessness served in Fiscal Year 17/18 • “No wrong door” • Clients are seen when and where they access services • Referrals and connections to behavioral health services, housing, and benefits as appropriate • “Meet people where they are” • DPH: Street Medicine, Engagement Specialists, Mobile Crisis • HSH: SF Homeless Outreach Team, Encampment Response Team, Larkin and HYA (Youth), Mobile Access, Family Access Points, Adult Access Points • HSA: benefits screening and enrollment at Navigation Centers, shelters, Access Points • HSOC: interagency approach for outreach and response 3 San Francisco Health Network
Roles and Collaborations • Public Health – Provide medical and behavioral health services • Homelessness and Supportive Housing – Outreach, shelter, housing, support services • Department of Human Services & Department of Aging and Adult Services – Benefits linkages, case management and conservatorship • Police Department – Outreach, refer to services, or detain • Departmental Collaborations • HSOC • Whole Person Care • Interagency Prioritization Workgroup • Coordinated Entry Mobile Access Points 4 San Francisco Health Network
Behavioral Health Spectrum of Care Behavioral Health Services PREVENTION, EARLY INTERVENTION, AND OUTREACH LOW ACUITY HIGH OUTPATIENT TREATMENT RESIDENTIAL TREATMENT CRISIS PROGRAMS Individuals may move between HOSPITALIZATION different levels of care AND dependent on their need. INVOLUNTARY TREATMENT LOCKED FACILITIES 5 San Francisco Health Network
Substance Use Scenario: John TAP completes level of care Individual John is placed in Groups assessment Therapy Recovery and refers to Residences for substance use vocational or temporary housing Medication other recovery residential to aid his recovery services treatment program John decides after Residential Treatment SF HOT engages with many attempted Program John to refer him to referrals that he would Coordinated Entry like treatment and Access Point. willingly goes to DPH Treatment Access DPH engagement Program (TAP) specialists also approach John, who struggles with substance use and lives on the Housing streets of the or long term care Tenderloin, for weeks. Outpatient Behavioral Health 6 San Francisco Health Network
Crisis Scenario: Alex If already connected, PES will notify Alex’s mental health provider 5150 PES stabilizes and releases If not connected Alex within 24 to mental health Outpatient hours care, PES will Police bring Alex mental Alex lives on the provide a referral to Psychiatric health streets of the Mission to outpatient Emergency Neighborhood and services Services (PES) has posed a threat to Social under a 5150 hold the community Workers Alex is referred to navigation services to be assessed for housing and benefits 7 San Francisco Health Network
Physical Health Scenario: Maria SF HOT, working Maria is assessed by Maria is living on the DPH Street Medicine alongside Street Coordinated Entry and is streets of SOMA and nurses encounter Medicine, refers Maria to assigned priority status. has open sores on her Maria and address her a coordinated entry Maria is screened for legs. medical needs. access point. benefits eligibility and assigned a Housing Navigator/ Stabilizer who places her in permanent supportive housing and provides housing stabilization follow up care. Street Medicine refers Maria for ongoing primary care services. 8 San Francisco Health Network
DPH Investments and Initiatives 2016-2019 Low Barrier Medications for Medical Respite Improved Linkages Addiction Treatment Adding peer counselors Added 31 beds to provide post-hospital recuperative care and sobering services for and social workers to Pilot program to provide addiction people too sick for shelters or the street . PES and Hummingbird. treatment with few barriers. Recovery Street Medicine Nov May Dec Residences and Shelter Health Low Barrier Medications Opening 72 new transitional Team expanded to provide for Addiction Treatment housing beds for people additional outreach and Expanded pilot program to exiting substance use medical services for people include 10 staff providing treatment programs . exp. homelessness. addiction treatment. July July July 2016 2017 2018 2019 Feb Mar Aug San Francisco Hummingbird Place Hummingbird Place Healing Center Increased capacity to 15 beds opened to Dec 40 beds added for 29 stabilization beds to serve as navigation Jan behavioral health center for clients with care for clients with behavioral health residential treatment. behavioral health Health Fairs HSOC issues. issues. First health fair dedicated to Interagency coordinated harm reduction services, response to street health promotion, and care behavior and people targeted to people experiencing experiencing homelessness . homelessness. 9 San Francisco Health Network
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