Shelter enrichment report :

2008·1.6 MB·English

by  San Francisco (Calif.). Local Homeless Coordinating Board

SANFRANCISCOPUBLICLIBRARY
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Cityand CountyofSan Francisco
Local Homeless Coordinating Board
Shelter Monitoring Committee
ShelterEnrichmentReport
ExecutiveSummary
ProcessOverview
The ShelterEnrichmentprocessbeganonFebruary 14,2008,whenMayorNewsomheldapress
conferenceannouncinghisinterestintransformingthetwolargestCityownedemergency
shelters,NextDoorandMulti ServiceCenterSouth(MSC),throughexpandingthemedical
respiteprogramandplacementofon-sitesupportiveservices, similartotheone-stopmodelof
ProjectHomelessConnect.TheLocal HomelessCoordinatingBoardandthe ShelterMonitoring
Committeebeganacommunityprocesstogetfeedbackonthemedicalrespiteandsupportive
servicemodel proposed. Fivecommunitymeetingsand fiveon-sitesheltermeetingswereheld
overasixweekperiodtogatherrecommendationsonmedical services, supportiveservices,and
acr-p"tr>the*ritvR, Pnnnh/ofSanFranciscosheltersystem.
-ommunityhighlightedkeyrecommendationsinall fourareas,the
ces, supportiveservices,andaccess. Belowarethegeneralthemes
nberofsleepingunitsintheemergencysheltersystemforboth
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Wewould liketothankeveryonewhocontributedtothe ShelterEnrichmentProcess.
DOCUMENTS DEPT.
MAY
BerniceCasey, PolicyAnalyst Ali Schlageter, PolicyAnalyst 1
ShelterMonitoringCommittee Local HomelessCoordinatingBo£ FRANCISCO
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MonitoringCommittee LocalHomelessCoordinating
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Cityand CountyofSan Francisco
Local Homeless Coordinating Board
Shelter Monitoring Committee
ShelterEnrichmentReport
ExecutiveSummary
ProcessOverview
TheShelterEnrichmentprocessbeganonFebruary 14,2008,whenMayorNewsomheldapress
conferenceannouncinghisinterestintransformingthetwolargestCityownedemergency
shelters,NextDoorandMulti ServiceCenterSouth(MSC),throughexpandingthemedical
respiteprogramandplacementofon-sitesupportiveservices, similartotheone-stopmodelof
ProjectHomelessConnect.TheLocalHomelessCoordinatingBoardandtheShelterMonitoring
Committeebeganacommunityprocesstogetfeedbackonthemedicalrespiteandsupportive
servicemodelproposed. Fivecommunitymeetingsand fiveon-sitesheltermeetingswereheld
overasixweekperiodtogatherrecommendationsonmedical services, supportiveservices,and
accesstotheCity&CountyofSanFranciscosheltersystem.
Recommendations
Throughouttheprocess,thecommunityhighlightedkeyrecommendationsinall fourareas,the
overall system, medicalservices, supportiveservices,andaccess. Belowarethegeneralthemes
statedthroughouttheprocess:
• Donotreducethenumberofsleepingunitsintheemergencysheltersystemforboth
singleadultsandfamilies
• Increasemedicalservicesforhomelessshelterresidents, howeverdonotreplacegeneral
accesssleepingunitswithmedicalrespitebeds
• Increaseservicesforhomelesspeopleandmaketheon-siteservicesaccessibletoall
people, notjustthosestayingatthesheltertheservicesarelocated
• Thecurrentwaysheltersleepingunitsareaccessedneedstochange[clientsstatedon
multipleoccasionsthattheyhadtowaitinline5-8hoursadaytoaccessaone-day
reservation]
• Solutionsmustbeclientfocusedandtheonlywaytocreateclientfocusedandguided
solutionsistogetclientinput
• AllrecommendationsshouldbealignmentwithContinuumofCareFive YearStrategic
PlanandtheShelterStandardsofCare.
A full listofall recommendationscanbefoundwithintheappendicesofthisreport.
Theproductofthisprocessholdsmanydonatedhoursofclient,provider,andcommunitytime.
Wewould liketothankeveryonewhocontributedtotheShelterEnrichmentProcess.
DOCUMENTS DEI
BerniceCasey, PolicyAnalyst Ali Schlageter,PolicyAnalyst
ShelterMonitoringCommittee LocalHomelessCoordinatingBoard
SS1ha3en8l0tFeHrraonMwcoainsricdtoo,SrtC.i,nAg2"9C14oF1ml0mo3iorttee SL1(oa44cn41a05lF)Hr5Haa5onr8cmr.iie1ssl8coe2ons,5sSCtC.A,oo29r"4d11iF0nl3aotoirngBe.rd
[phone] www.sfgov.org/lhcb
www.sfgov.org/sheltermonitoring
LocalHomelessCoordinatingBoard
ShelterMonitoringCommittee
ShelterEnrichmentReport
May 12,2008
Page2
ShelterEnrichmentReport
ShelterEnrichmentProposal
OnFebruary 14,2008,MayorGavinNewsomheldapressconferenceatSt. Vincentde Paul's
Multi ServiceCenterSouth(MSC)to"pledge [his]commitmentto improvethesheltersystem in
SanFranciscothroughexpandedaccesstomedicalrespiteandon-sitesupportiveservices." By
invitationfromtheMayor'sOffice,theLocal HomelessCoordinating Board(LHCB)andthe
ShelterMonitoringCommittee(SMC)beganasixweekcommunityoutreachefforttoget
recommendationsonMayorNewsom'sproposalofa"specific redesigncomponents [that] will
focusontwoareas: expandedmedicalrespiteandplacementofon-sitesupportiveservices
similartotheone-stopmodel ofProjectHomelessConnect." AttheirMarch meetings, boththe
LHCBandSMCapprovedanoutreach proposal drafted by stafftobegina Shelter Enrichment
process.Atthefirstoffivecommunitymeetingson March 19,2008, itwasclear from
communityfeedbackreceivedthatashelterredesignwould needtoexpand pastthetwo large
sheltersindicatedonFebruary 14,2008, MSC SouthandNextDoor,andthetwoareas, medical
respiteandon-sitesupportiveservices.
ShelterEnrichmentProcess
LHCBPolicyAnalystAli Schlageterand SMC PolicyAnalystBerniceCasey planned the firsl
TownHallmeetingonMarch 19, 2008. FacilitatedbyLHCB MemberDr.Chirstinc Ma. the
meetingdrewover80participants. Thefocusofthe firstmeetingwastoget feedback on the
proposalofimprovingthesheltersystemthroughexpansionofmedical respite,on-site
supportiveservices,andaccess. Themeetingprovidedanopportunity forrepresentatives from
theLHCB, SMC,TenYearPlan ImplementationCouncil (TYPIC), Human Services Agency
(HSA),DepartmentofPublic Health (DPH), andtheMayor'sOfficetodiscusstheprevious
communityworkcompletedonhomelesspolicy, specificallythecreationoftheTen YearPlan to
EndHomelessness,theContinuumofCarePlan,theStandardsofCare, andtohearfrom policy
makersonhowtermssuchas"respite"aredefinedwithintheCity&CountyofSan Francisco.
ByprovidingabaseofwhatworktheCity&CountyofSan Franciscohadalready
accomplished,thegoalofthismeetingwasto identifywhattypesofsupportiveservices
consumersandproviderswould liketoseeinthesystem, utilizingaProject HomelessConnect
(PHC)approach [servicesatonesite;utilizationofalargevolunteerbase;and financial and
resourcebasedsupportfromtheprivatesector],theneed foran increase in medical serviceson-
site, includingrespitebeds,andthemannerinwhichallservices, includingshelter, could be
accessedwithinthesheltersystem.
Atthismeetingandthefourmeetingsthatfollowed,aswellasthefiveshelter-specificmeetings
thatwereheld,thefollowingsystemrecommendationswereraisedrepeatedly:
• Donotreducethenumberofsleepingunitsintheemergencysheltersystem forboth
singleadultsandfamilies
• Increasemedicalservicesforhomelessshelterresidents,howeverdonot replace
generalaccesssleepingunitswith medicalrespitebeds
• Increaseservicesforhomelesspeopleand maketheon-siteservicesaccessibletoall
people,notjustthosestayingatthesheltertheservicesarelocated
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• Thecurrentwaysheltersleeping unitsareaccessed needstochange [clientsstated
on multipleoccasionsthatthey had towaitin line5-8hoursadaytoaccessaone-
day reservation)
• Solutionsmustbeclientfocused and theonlywaytocreateclientfocused and
guided solutionsistogetclientinput
• All recommendationsshould bealignmentwith Continuum ofCareFiveYear
StrategicPlan and theShelterStandardsofCare.
Therewere fourcommunitymeetingsheldafterMarch 19, 2008. OnApril 3, 2008, amedical
servicesworkgroupmeetingwasheld. Thegroup identified20recommendationstoimprove
clientaccesstomedicaland health services. OnApril 9, 2008,asupportiveservicesworkgroup
meetingwas held. Thegroup identified29recommendationsto improveclientaccesstoservices
inthesheltersystem. OnApril 23, 2008,anaccessworkgroupwasheld. Thegroup identified
20recommendationsto improveclientaccesstothesheltersystemasawhole. Thecommunity
reconvened onApril 28,2008,to identifythekey recommendationstobe forwardedtothe
LHCBandtheSMC fortheirreviewbeforebeingsentontotheMayor'sOfficeandtheBoardof
Supervisors.
ShelterEnrichmentRecommendations
MedicalServices
Atall thecommunitymeetings, itwasnotedthatadditionalmedical servicesare neededtomeet
thehealth needsofclients. Iftheanswerisrespitebeds,therespite bedsshould beprovided in
additiontocurrentunits, notwiththereplacementofany sleepingunitsatshelters. Manyspoke
oftheneed forextended health clinic hours, moreclinicianson-site, moremental health services,
theuseofamedical rovingteam, and healthtrainingforboth staffandclients.
The followingarethe fivekey recommendations formedical services. Acomplete listof
Medical Recommendations is located in Appendix 1 ofthisreport.
• Havea roving medical team orvan thatcomestothesiteon a regularand consistent
basis.
1 Mental healthandcounselingshouldalsobeapartoftherovingservice.
2. A mobile health vanwouldallow forservicetobeofferedatthesheltersopenedonly
atnight.
• Expand currenton-sitemedicalclinic hours.
1 Forlargershelters,theclinicexpandstofivedaysperweekatconvenienttimes,
particularlyeveninghours.
2. Atresourceanddrop-incenters,clinichourscorrespond [and ifneeded,expand]to
whenclientsaremaking [andwaiting for] reservations.
• Have medicalstafftrain and educateboth clientsand staffon chronichealth issues,
howtoensurea healthyenvironment,and provide basictreatmentforavarietyof
common health conditions [aslistedbelow]
1. RequestthatDPH developcurriculum forshelterstaffthatwouldreviewtriage
techniquesforwoundcare,epilepsy,asthma, pain management,occupationaltherapy,
tuberculosis, hepatitis,and sexuallytransmitteddiseases.
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2. Inaddition,utilizingexistingprintedresourcefromNationalHealthCareforthe
Homeless,distributeandpostpamphletsregardingchronichealth issuesatresource
anddrop-incentersandshelters.
• Increase"rest-beds"
1. A"rest-bed" [orhealthbed] isamedicalstep-downfrommoreacutemedicalcareas
wellasastep-upincarefromageneralshelterbed.
2. Thepurposeofa"rest-bed"istoprevent[re-] hospitalizationandtomeettheneedof
non-acutecare.
3. Clientshouldbereferredto"rest-beds"fromthehospital,urgentcare,respitecenters,
out-patientclinics,and/orcasemanagerattheshelterandresourceanddrop-incenter.
• Usealowthresholdmodeltoensurethatallmedicalservicesareeasilyaccessedand
tominimizetheunnecessaryhurdlesforthatclientstryingtoaccesssitesand
services.
SupportiveServices
BeforethefirstTownHallmeeting,servicesproviderswereaskedto identifytheservices
offeredattheirsite. GiventheFebruary 14, 2008proposalofprovidingon-sitesupportservices,
ProjectHomelessConnectmodelproposedbyMayorNewsom,asurveywasdistributedto
serviceproviderstoassesswhichoftheservicesofferedattheDecember2007ProjectHomeless
Connectwereofferedattheirsite. Onlyonesingleadultshelterprovidedover60%ofthose
services. Fordetailsofon-sitesupportiveservicescurrentlyofferedbyserviceprovidersand
dataoftheuseoftheservicesprovidedattheDecember2007ProjectHomelessConnect,please
reviewAppendix2.
TheApril9,2008 SupportServicesworkgroupmeetingalsodiscussedutilizingaresourcecenter
modelforon-siteservicedelivery. TheMissionNeighborhoodResourceCentermodelwas
presented.
Thefollowingarethe 14keyrecommendationsforsupportiveservices. Acomplete listofthe
SupportiveServicesRecommendationsis locatedinAppendix3ofthisreport.
• Provide24-houraccesstomentalhealthservices
1. Employatherapistforeachsiteand/orprogram, availableMonday-Friday
2. Provideaccesstoamentalhealthprofessionalafterhoursandonweekends
3. Providementalhealthtrainingtostaff
• Createanassessmenttoolwhichmeasuresclients' needs [upon intake] from mental
health,nutrition,physicalhealth,employability,and housing
• Createandmaintainsystem-wide,stream-lined housingdatabasewhich isupdated,
complete,andeasyforcasemanagerstouse
• Createaseniorspecificshelter
1. CreateashelterforGoldenAgeclients55 yearsandolder
2. Provideintensivecasemanagementservices,similartothoseprovidedthroughthe
HomelessOutreachTeam
3. Identifyclients65yearsandolderwhomayneedadditionalservices
• Provideservicesatonesitebutletallclientsaccessthoseservices
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• Providetrainingforcasemanagers [andothershelterstaff] toensurethatallcase
managers [andothershelterstaff] havethesameinformation on resourcesand
servicesforclients
• Createan employmentprogram on-siteatthesheltersin partnershipwithaday
laborprogram
• Providemoreeducationalprograms,includingliteracy,GeneralEducation
Development((ill)),computerskills,andvocational programs
• Createaclientsatisfactionsurveythatcanassistin determiningifservicesarebeing
providedsuccessfully
1 Provideincentivestoclientsforcompletingthesurveys
2. Provideassistanceandencouragementforcompletingthesurveys
3. Provideanalternate formofdelivery sothatclientscan sendtheircommentsdirectly
totheCity&CountyofSan Francisco
• Providespecificservicesforundocumented clients,particularlyhousingand
employment
• Establish betterclienttostaffratios
1. Suggested Ratios: CaseManagement25:1 and FloorMonitors20:1
• Raisehiringstandardsforstaff
1. Providetraining forexistingstaff
2. Provideannualtrainingsforstaff
3. Emphasisonconflictpreventionresolutiontrainingandothertrainingoptionsby
removingsecurityguardsfromsitesandusethosefundstotrainstaff[NOTE: when
thisitemwasdiscussed inthe largergroup, someclientsrequestedthattherebe
additional securityguardsatsites]
4. Providehigherwagesforstaff
5. TheCity& CountyofSanFranciscoshould providehiringguidelinestoallshelters
• Createashelterforwomenonly
1 Createmore sleepingunits forwomen;whilethere isaneed formoresleepingunits
formen,thereneedstobemoreunits forwomenthatcorrespondtothepopulation
sizeofhomelesswomenofSanFrancisco.
2. Createawomen-onlyshelterinthe WinterShelterSystem
• HaveGeneralAssistance(CountyAdultAssistanceProgram)workerson-siteatthe
shelters
Access
Atthecommunitymeetings,throughcommunitydiscussionandclient'scomments, itwasclear
thataccessto San Francisco'ssheltersystemneedstobe improved. In particular, peoplewere
concernedwiththedifficulty forseniorsandthosewithdisabilitiesaccessingbeds,the longdaily
waitspeopleencounterwhengettingareservation,andthe factthatempty bedsareinthesystem
eachnight.
Thefollowingarethesevenkeyrecommendationsforimprovingclientaccesstotheshelter
system. Foracomplete listofalltherecommendations, pleasereviewAppendix4.
• AnalyzetheCareNotCash (CNC) programs
1. TheanalysisshouldfocusonthenumberofCNCbedsunoccupiedeachnight.
.
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• Trackwhattypeofsleepingunitisvacanteach night
1. Theanalysiswoulddefinetheaccesspointtothatvacantsleepingunit: CAAP,
CAAPPending,casemanagement,etc.
2. Trackwhere,whichsites,vacanciesoccur
3. Trackatwhattimessleepingunitsbecome"vacant" intheCoordinated Homeless
AssessmentofNeedsandGuidancethroughEffectiveServices(CHANGES)
• Increasethenumberofsleepingunitsthatthe resourcecenterhasaccessto make
reservations.
1. Currentlytheresourcecentershaveaccessto38%ofthetotal units intheshelter
system.
• Allturn-awaysshould betrackedeach dayand nightatthe resourcecentersand at
theindividualshelters.
1 Aturn-away isdefinedasan individualattemptingtomakeareservationatanytime
duringthedayornightand notbeingabletoaccessasleepingunitatthattime.
2. Typesofturn-awayareclassified intwoways,a)an individual isunabletomakea
reservationatXtimeastherenosleepingunitsavailable inthesystemand b)an
individual isunabletomakeareservationatXtimeasthesheltertheyarerequesting
doesnothaveanavailablesleepingunit [personalchoice].
3. Thetrackingmechanismwouldnotewhethertheturn-awaywasbasedonpersonal
choiceortheavailabilityofasleepingunit.Themechanismwould beusedatthesite
throughouttheday,note ifthe individualwasunabletomakethereservation based
onavailability,andatwhattimeasleepingunitwasmadeavailablewithin
CHANGES.
4. Clientsshouldhavetheoptiontofilloutasurveydocumentingthetimetheywere
turnedaway,whichsheltertheycouldnotaccess,andthereason.
• Sleepingunitreservationsshould beabletomadeon-siteatshelters
1. TheStandardsofCareCity RequirementsSection 20.403 (a) Ensure24-hourclient
accesstoashelterand provideon-siteshelterreservations forcurrentshelterclients.
2. Allowsleepingunitreservationsand reservationextensionstobemadeon-siteat
shelters,notjustatresourcecenters.
• Dropavailablesleepingunitsatanearliertime
1. Itwasreportedthatsomesheltersdrop"vacantbeds"as lateas 11:00PM, midnight,
andtheearlymorninghours.
• UsetheSF311 freephonelineasanotherwaythatsomeonecan makeashelter
reservation24hoursaday.
CommunityProcess
Themostconsistentcomplaintaboutthecommunityprocesswasthe lackofclientinvolvement
inthemeetings. Ms.CaseyandMs. Schlageterheldfivecommunitymeetingsatsheltersites,
HospitalityHouse, DoloresStreetCommunity Services,MSC South,NextDoor,and Sanctuary.
Inaddition,throughouttheprocess,theLocal HomelessCoordinatingBoardandthe Shelter
MonitoringCommitteereceivede-mailsandcallsabouttheprocess. Twocommunity
organizations, HumanServicesNetworkandtheCoalitiononHomelessness,submittedwritten
recommendationsontheShelterEnrichmentprocess. Bothletterscanbe found inAppendix5.
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Continuum ofCarePlanand theStandardsofCare
Inrecognitionofthecommunityeffortsthathavealreadytakenplace, it isimportanttorecognize
thecrossoverbetweentherecommendationswithinthe ShelterEnrichment, ContinuumofCare
Plan, and StandardsofCare legislation. InAppendix6,thereisabreakdownofthemedical,
services,andaccessrecommendation intersections.
BudgetConstraints
OnApril 15,2008, MayorGavinNewsom submittedtotheBoardofSupervisorsaResolution
declaring ittobeofficialCitypolicythatnonewset-asidesorothermandatoryappropriationsbe
addedtotheCityCharterunlessthemeasurealsoidentifiesorprovidesaspecific,adequatenew
sourceoffunds.The issueoffundingwasaconcernthroughoutthisprocess. Torespectthe
communityprocess,thekeyrecommendations formedical,services,andaccessshouldgo
forward. The Human ServicesAgency, DepartmentofPublic Health,andotherpolicybodies
shouldworkwiththeMayor'sOfficeandtheBoardofSupervisorstoidentifyappropriate
funding, ifpossible. Thefollowingrecommendationsarebeingproposedas lowcostornocost;
however,abudgetanalysiswouldneedtobeconductedbytheCitydepartmentsidentifiedbelow
todeterminethecost:
• Havemedicalstafftrainand educate both clientsandstaffonchronichealth issues,
howtoensurea healthyenvironment,and provide basictreatmentforavarietyof
common health conditions
Implementation: a) UtilizingNationalHealthCarefortheHomelessfreetrainings; b)
DPHcouldworkinpartnershipwithlocaluniversityhealthprogramstoprovidea
curriculum-basedtrainingtoallemployees
• Increase"rest-beds"
Implementation:AccesstobedrestismandatedwithintheStandardsofCarelegislation
• Createan assessmenttoolwhich measuresclients' needs [upon intake] from mental
health,nutrition, physicalhealth,employability,and housing
Implementation: HSA andtheDPHcouldcreateastandardizedassessmenttool, in
partnershipwiththeShelterDirectors, incorporatingexistingtools
• Createand maintainsystem-wide,stream-lined housingdata basewhich isupdated,
complete,and easy forcasemanagersto use
Implementation: WorkinginpartnershipwiththeHSA, DPH, andcommunityhousing
organizations, createawebaccessiblelistthatcanbeaccessedbythecommunity.
Need: IdentifyanexistingstaffwithinHSA orDPHtotakethelead.
• HaveGeneralAssistance(CAAP)workerson-siteattheshelters
Implementation:Apilotprogramatalargeshelter, e.g. MSCSouthorNextDoor, where
aCAAPworkerwillworkon-site20hoursaweek[minimum]andtrackoutcomes.
• Providetrainingforcasemanagers [andothershelterstaff] toensurethatallcase
managers [andothershelterstaff] havethesameinformation on resourcesand
servicesforclients
Implementation: Employingasimilarmodelfortrainingstaff[listedabove], HSA and
theDPH, willprovideannualtrainings.
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Need:AnanalysisoftrainingneedsidentifiedthroughHSA'smonthlyShelterDirector's
meetingsandtheincorporationoftheninetrainingareasrequiredbyallstaffwithinthe
StandardsofCare.
Createaclientsatisfactionsurveythatcanassistindeterminingifservicesarebeing
providedsuccessfully
Implementation:LocalHomelessCoordinatingBoardandtheShelterMonitoring
Committeewillworkwithcommunitygroupsandclientstoidentifyincentives.
Need:Self-addressedenvelopestothecontractmonitoragencyshouldbeprovidedwith
eachsurvey. TheLHCBandSMCcanprovideananalysisofeachsite'sresponses.
Trackwhattypeofsleepingunitisvacanteachnight
Implementation: ThisinformationisalreadyavailablethroughHSA.
Need:Areportshouldbedoneonamonthlybasisandthatinformationprovidedtothe
LHCBandSMC
Allturn-awaysshould betrackedeachdayand nightattheresourcecentersand at
theindividualshelters.
Implementation:LocalHomelessCoordinatingBoardandtheShelterMonitoring
Committeewilldoquarterlyturnawaychecks. Inaddition, contractmonitorsshould
workwithagenciestoprovideatrackingtool. Forexample, theHumanSer\>icesAgency
hasprovidedsiteswithatrackingsheettorecordturnaways.
Increasethenumberofsleepingunitsthattheresourcecenterhasaccesstomake
reservations.
Implementation:Aftercompletionoftheaboveanalysis, theHumanServicesAgency
shouldreassessresourcecenteraccessallocation.
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Appendix
1
Medical Services Recommendations