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    Integrating Services in San Francisco to Tackle a Primary Cause and Consequence of Homelessness

    By Brett Andrews–

    For decades, a medically focused paradox has existed within the U.S. health care system. Americans spend substantially more money on health care than any other industrialized nation. So why do we have such relatively mediocre health outcomes? The dissonance is most striking in comparison with Scandinavian countries that spend considerably less on both health care per capita and as a percentage of GDP. Yet they achieve substantially better health outcomes than we Americans do because they invest in social health.

    On a local level, we observe these dynamics in the health of people living on our streets. Homelessness is a growing problem in San Francisco, and health issues are a primary cause, consequence, and crutch of homelessness. Despite spending approximately $300 million annually on homelessness, service outcomes for San Francisco’s homeless population have remained relatively unchanged over the past decade.

    Late last year, the Point-in-Time Count, a census of homelessness, revealed even more extreme numbers and statistics—and increasing health issues. The number of unhoused San Franciscans increased by nearly 1,000 to approximately 8,000. For two out of three of these individuals, up to 16% over two years, health conditions limit their ability to hold a job, live in stable housing, or to take care of themselves. Given these historic outcomes, it’s hard to deny the correlation, if not causation, of a fragmented system of care and considerably less than ideal health and economic outcomes in our community.

    We are poised for change. A deep look into San Francisco’s service delivery model reveals a strong foundation of services and robust data about our marginalized population, but also a siloed and uncoordinated system of care structure with limited capacity to share information. Evidence is mounting that physical health outcomes can be improved by integrating social services such as aging care, housing assistance, mental health and substance use treatment, benefits and health care counseling, nutrition programs, employment services, and emergency financial assistance.

    San Francisco has taken up the charge of assessing its system of care, with an eye toward integration. Recent efforts like the Whole Person Care Initiative, the hiring of San Francisco’s Behavioral Health Reform director, and Mental Health SF are strong examples of emerging and innovative public health and community-based partnerships that aim to serve the complete person. It’s necessary. Fragmentation of health care services doesn’t work. None of us is one-dimensional.

    Many local systems of care and health and human services nonprofits across the country have needed to restructure, with a priority focus on integration because it works. PRC is a prime example.

    Valuing the effectiveness and efficiency of integrated services, PRC consolidated three organizations—Positive Resource Center, a workforce development and legal advocacy agency; Baker Places, a mental health and substance use disorder residential treatment agency; and AIDS Emergency Fund, an emergency financial assistance agency—and designed a framework to de-silo funding sources, center client perspectives, and integrate specialized services into a continuum of treatment and social services.

    The result gives individuals the necessary tools and support to move from crisis to stabilization, to reshape and reclaim their destiny: just the kind of social investment the crisis of poverty and health in San Francisco will require.

    Leading PRC since 2003, Brett Andrews has overseen PRC’s evolution from a small HIV/AIDS legal service agency to an integrated social and behavioral health provider bent on fighting poverty, stigma and isolation by uplifting marginalized adults and affecting the social conditions of health. He holds an M.A. in Industrial/Organizational Psychology from George Washington University, received the San Francisco Pride Celebration’s Heritage Award for 10+ years of service in 2017, and was appointed to the San Francisco Mayor’s Methamphetamine Task Force.

    Published on January 30, 2020