DPH outlines coordinated street care model, cites tens of thousands of encounters and plans to scale data integration

The San Francisco Department of Public Health on April 16 told the Health Commission that city'wide street care teams have expanded coordinated outreach and clinical services to people experiencing homelessness and behavioral-health crises, and that those teams logged more than 23,000 encounters in 2023.

Dara Patho, director of Whole Person Integrated Care, and Kathleen Johnson Silk, program manager for BEST Neighborhoods, described a multiagency response that includes the street crisis response team (SCRT), street overdose response, the post-overdose engagement team (POET), street medicine, HSOC and the Office of Coordinated Care. "We are part of a cross-city effort to really work instead of in silos and wrap around people as whole people," Johnson Silk said.

The presentation emphasized a neighborhood-based, multidisciplinary model. BEST Neighborhoods, launched in March 2023, reported almost 8,500 engagements in its first year and more than 1,100 linkages to mental health, substance-use and housing services; the program budget is about $6,000,000, the presenters said. Street medicine reported roughly 3,000 unique patients and about 11,000 encounters last year with an approximate $5,000,000 budget. POET had about 1,500 encounters for roughly 600 clients, with 783 referrals to treatment and a budget near $4.5 million.

The presenters used a composite case study, "Mary," to illustrate how teams move from emergency contact to sustained care: SCRT or 911 contacts prompt OCC triage referrals, BEST Neighborhoods conducts repeated outreach, street medicine provides wound care and street-based psychiatry can initiate medications; shelter placement and intensive case management complete the pathway. "We're building trust by coming back," Johnson Silk said of repeated outreach visits.

Commissioners pressed staff on measurable outcomes and data systems. Staff said clinical documentation for many teams is recorded in EPIC and that Astrid, a cross-department database, is being used to identify "shared priority" individuals and high utilizers across city systems. Presenters acknowledged data gaps for some downstream treatment outcomes (for example, confirming residential treatment admissions) and committed to returning with more integrated benchmarks and comparisons to other jurisdictions.

The presentation also highlighted operational adjustments: POET shifted to focus on higher-acuity individuals and improved follow-up rates (SCRT follow-up rose from a 64% baseline to as high as 80% in 2022), and teams continue quality-improvement work on screening, telehealth and linkage metrics. Commissioners asked for realistic, comparative benchmarks (e.g., expected buprenorphine starts and referrals) and for stress-testing capacity given rising need; staff said Astrid and integrated data will help produce those projections.

The commission thanked staff and urged follow-up with more precise targets and comparative examples from other cities. The next steps identified were to provide the requested counts and data, return with benchmarked performance goals and continue Astrid'based shared-priority work.