San Francisco, CA
Positive Resource Center (PRC) aimed to address social determinants of health associated with poor HIV outcomes through its Housing Planning Program, funded as part of a Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) initiative. From 2017-2019, and operating in sites within San Francisco’s Tenderloin and South of Market districts, the program provided intensive housing and employment counseling to people with HIV who were unstably housed. The Housing Planning Program helped participating clients to make the transition into stable housing and to obtain employment, while remaining engaged in HIV treatment. An evaluation of the intervention found that Housing Planning Program’s efforts resulted in increases in clients obtaining stable housing, and in their incomes from baseline to six months after enrollment.
Rates of homelessness in San Francisco continue to rise1 and many people experiencing homelessness cope with other social determinants of health that negatively impact their ability to find—and remain engaged in—HIV care. Prior to the launch of Housing Planning Program, PRC conducted an independent investigation to understand what long-term housing and employment services were available to people with HIV residing in treatment facilities and HOPWA-funded housing. After conducting interviews with staff at several housing sites, PRC learned that many of them did not have resources dedicated to client discharge planning focused on long-term housing placement or career preparation. It also became evident that there was no centralized location or agency that offered long-term housing planning. The need for these services was clearly evident, and PRC could fill these service gaps with the Housing Planning Program.
“PRC’s continuum of services delivers evidence-based, wrap-around supports that move the most high-risk, marginalized individuals forward on a path toward long-term stability and success—effectively preventing and reducing homelessness, improving public health, and enhancing the local workforce.”
On the first day of a client enrolling in the Housing Planning Program, a staff member worked with the client to complete a needs assessment questionnaire and acuity screening tool to assess the severity of the client’s needs in a range of domains, including medical, mental health, substance use, housing, income, and food security. Information collected on these two assessment tools was then used to develop a tailored service plan for the client. Since most clients in this program were already well connected to HIV services, the service plans focused on housing and employment supports.
Program staff drew from the assessment tool findings to refer clients to support services, including:
- Enrollment in Coordinated Entry (the gateway to San Francisco’s system of programs and opportunities for people experiencing homelessness) and DAHLIA (San Francisco’s affordable housing portal)
- PRC’s Workforce Development’s Getting to Zero program, which links clients to high-touch vocational rehabilitation services
- Identification of alternative housing options, such as temporary housing and residential treatment for substance use and/or mental health disorders
- Periodic check-ins to support retention in HIV care
Program staff were also available to accompany clients to service provider appointments and housing interviews.
Housing Planning Program staff relied on so-called ‘tangible reinforcements’ to help establish relationships with clients. These reinforcements included water and food during client meetings and free hygiene kits supplied by a local nonprofit. One program staff member shared a collage of housing complex pictures with clients, so they could see where they might live.
PRC enrolled 100 people into the Housing Planning Program between 2017 and 2019. Employment, housing, and health-related data were collected during baseline interviews at the time of enrollment, and at six and 12 months after enrollment. Overall, the Housing Planning Program found its greatest success with housing and employment status.
| Category | Information |
|---|---|
| Evaluation data | Clients’ housing and employment status |
| Measures | Number/percent of clients:
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| Results |
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Source: PRC Housing Planning Program Manual
Promotion and marketing. The Housing Planning Program was initially promoted through word-of-mouth, interagency communications to partners, and through agencies in San Francisco’s HIV services network. Staff made presentations at local community-based organizations serving people with HIV and handed out flyers outlining the program’s purpose, services, and eligibility requirements. Program flyers were also emailed to the San Francisco HIV Frontline Organizing Group listserv, which sends messages to over 400 San Francisco HIV service providers.
Gaining buy-in. PRC’s chief executive officer, development team, and finance department supported the Housing Planning Program early on. PRC also developed formal agreements with external partner agencies such as Lutheran Social Services of Northern California.
Staff recruitment and training. Housing Planning Program’s team consisted of a project director; two integrative health analysts who worked with clients and provided service interventions; and a staffer who recruited and conducted intakes with clients, as well as collected and analyzed all program data. These staff drew from their case management experience and previous work with homeless individuals. Additionally, PRC required that they complete the U.S. Department of Labor’s and the U.S. Department of Housing and Urban Development’s Getting to Work training curriculum for HIV service providers, and trainings on client privacy and confidentiality from the San Francisco Department of Public Health.
Developing strong partnerships. Staff maintained regular communication about client goals and activities with service providers in the community, often meeting in person. Provider partners included Lutheran Social Services for wraparound services such as housing advocacy, money management services, and life skills counseling; Ward 86 for medical and social services; and Ferguson Place for mental health and substance use disorder treatment services. Establishment of these strong partnerships fostered early communication about housing challenges and medical needs.
Client and community input. Housing Planning Program staff gathered client input on the program by participating in community meetings with other service providers, including the San Francisco AIDS Foundation, Lutheran Social Services, and Larkin Street Youth Services. Through these meetings, they learned about client needs and coordinated on challenging cases; discussed disconnected housing assistance programs in San Francisco and how to centralize them; and analyzed client outcomes data.
PRC’s Housing Planning Program was partially funded by the Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) initiative entitled the HIV, Housing, and Employment Project. PRC used preexisting funding from the city and county of San Francisco for its Workforce Development and Emergency Financial Assistance programs. PRC also received funding to help support the Housing Planning Program from the California Department of Rehabilitation, and from RWHAP Parts A and B.
- The Housing Planning Program model offered a full array of onsite services, with easy access to emergency financial assistance, employment services, and legal services; clients could often access these services on the same day. This easy access to services motivated clients to participate in the intervention.
- During intake, clients were asked to rank their most “pressing and immediate” needs, which allowed Housing Planning Program staff to focus on what clients needed to address most quickly. This helped them offer engaging and client-centered resources and referrals that also meant clients left the first meeting with something tangible to address their most critical needs. Staff were able to use their time and resources more efficiently, and to avoid burnout and overload from not having clear priorities.
Implementation Resources
- PRC Housing Planning Program Manual
- PRC Coordination of Supportive Employment and Housing Services Demonstration Site Summary
Presentation
Additional Resources
- San Francisco Department of Homelessness and Supportive Housing. San Francisco. 2024. Homelessness: Point-in-Time Count and Report.