Inside the paramedic-led team conducting homeless sweeps in San Francisco

The Healthy Streets Operations Center team includes members of EMS-6, plus clinical social workers from the city's Department of Public Health


Michelle Robertson
SFGate, San Francisco

SAN FRANCISCO — Between June 2020 and June 2021, San Francisco conducted 679 "encampment resolutions," the phrase city officials use to describe clearing homeless encampments in the city.

The department that conducts these "resolutions" is known as the Healthy Streets Operations Center (HSOC), a multidisciplinary effort of multiple agencies that is highly controversial among homeless rights advocates in the city.

Homeless tents line Main Street in San Francisco's financial district during shelter in place order.
Homeless tents line Main Street in San Francisco's financial district during shelter in place order.

"What we have seen time and again is that HSOC's operating procedures are not being followed," Jennifer Friedenbach, the executive director of the Coalition on Homelessness San Francisco, wrote in a recent Street Sheet piece titled "When Tents are Removed, There's No Way Home." "But even if they were, HSOC's approach is highly problematic, trauma-inducing and likely to exacerbate homelessness."

Friedenbach said that even though HSOC says it will not conduct sweeps unless it has enough services for people, "that is just not the case."

"They maybe have shelter beds ... but living in a congregate space doesn't work for many people," she said. "These people might not want to share an indoor space with hundreds of people."

In the Street Sheet piece, Friedenbach calls for the dismantling of HSOC and argues that a "compassionate alternative response to homelessness that is not an institutional response" "fully equipped to work with people and try to address their needs" should take its place.

In the meantime, the city has HSOC. SFGATE wanted to comprehend what exactly its goals are and how it hopes to accomplish them. To understand the controversial agency, SFGATE spoke with Mary Ellen Carroll, the executive director of the Department of Emergency Management, which coordinates the city's response to homeless people's encampments.

What is the goal of "encampment resolution"?

Carroll said the primary goal of "encampment resolutions" is to bring services to individuals on the street, but it is not the only goal.

"We are also trying to create safety, which means sanitation and cleanliness also," she added.

The overarching purpose, especially during COVID-19, is to make "the street safe for everyone. ... Kids deserve safe passage to school or the store, and it's important for us to maintain safety for all of us."

Who typically clears encampments?

The Healthy Street Operations team clears encampments. The team consists of the Department of Homelessness and Supportive Housing, the Department of Public Health, the Department of Emergency Management, the Department of Public Works, the San Francisco Police Department, the San Francisco Municipal Transportation Agency and San Francisco Recreation and Park. The Fire Department is also involved when a medic is needed.

Who exactly orders that an area be cleared?

HSOC orders encampment clearings in conjunction with the agencies listed above.

Who decides where to clear an encampment and when?

HSOC conducts regular tent and vehicle counts, looking at encampments that contain six tents or more, Carroll said.

"With this info, we develop a schedule for developing encampment resolutions," she said.

She said "there's all kinds of things" that determine where encampments lie on this schedule, including whether a school or day care is opening nearby and there's a "risk," or a construction project is about to break ground.

"Generally speaking, we look at the largest ones and the ones creating the largest risk for folks in the surrounding area," Carroll said.

Carroll said HSOC also tracks 911 and 311 calls "so in a sense, we're tracking hotspots in the city and looking to see if it aligns with the list that we have and what we know from our street operations."

Do those involved receive special training?

For the most part, yes. The team includes members of EMS-6, the main paramedic unit for Emergency Services, including a paramedic captain trained in community street medicine. There are also clinical social workers from the San Francisco Department of Public Health involved.

All the other nonclinical staff have training that includes the police and public works folks on the street.

"Everybody in the field has experience of different levels," Carroll said.

How big is the team clearing an encampment on any given call?

The size of the team depends, but it generally ranges from four to eight people. Typically it's a core group of a paramedic and homeless outreach team members (two to four people).

A group comes in later to remove any left behind items, typically consisting of two to six people with two police officers.

Which places are most frequently cleared?

Carroll said there are "certain areas" that require frequent attention, including the alleys off of Van Ness Avenue.

"There are certain areas we've gone back over 20 times," she said. "Some areas we have been successfully able to keep free of encampments, but other areas we haven't."

When will the city not go through with a "resolution"?

"One [scenario] would be we go to a resolution with say 10 beds, but there's 12 people that want those services. Then we'd stop the resolution," Carroll said.

Friedenbach disputed this claim. "It's just not true," she said.

"When we've looked at FOIA requests, we've noticed they'll have a number of people in the encampment and not the right amount of shelter beds. We also know that from observation," she said.

Carroll said it's "important to understand that we are required to follow the law, which means we can't do a resolution without having an alternate option for the person that is on the street."

What happens if people don't want the offered services?

Carroll said if there are 10 beds and only five people show interest, the remaining individuals are asked to pack up and move from the area. Friedenbach corroborated this.

Currently, people can stay in shelters "indefinitely," according to Deborah Bouck with the San Francisco Department of Homelessness and Supportive Housing.

"We are under a policy of automatic stay extensions since the beginning of the pandemic," she said by email.

Are peoples' belongings taken during the process?

Carroll said people's belongings are not taken from them; however, when they go inside shelters, they are asked to relinquish tents.

If anyone declines services, their tent will not be taken from them, Carroll said.

Friedenbach told SFGATE that this is not always the case. Sweeps are conducted typically from 7 a.m. to 10 or 11 a.m., and in that time, not everyone is able to pack up fast enough, forcing them to leave belongings behind.

"They have to scramble and pack up really quickly," she said. "A lot of times, we see people that are elderly and can't move that fast, or they have impaired mental functioning, developmental disability type stuff. ... You can imagine how hard it is having to get everything together that fast."

What resources are devoted to HSOC?

"I think part of it isn't so much money, but the challenge has been having the resources that people are more likely to be enthusiastic about," Carroll said. "Safe Sleep [city-sanctioned tent sites] was created during COVID and that we still have, and that's been a very popular resource for folks. Congregate shelters are probably the least popular. That's not any secret."

The resources that go into HSOC include shelter beds, Safe Sleep sites, navigation centers and treatment beds, among others. There is existing staffing in each department.

Beyond an HSOC manager, "there is not a large budget or really any specific separate budget," Carroll said.

In Mayor London Breed's proposed 2020-2021 budget, she advocated to allocate $4 million to HSOC over two years to "maintain existing services in participating departments with significant new funding directed towards additional staff at HSH and the Department of Public Health."

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