Co-published with ProPublica. This article was produced for ProPublica’s Local Reporting Network in partnership with the San Francisco Public Press. Sign up for the Public Press newsletter and ProPublica’s Dispatches to get stories like this one as soon as they are published.

Tabitha Davis had just lost twins in childbirth and was facing homelessness. The 23-year-old had slept on friends’ floors for the first seven months of her pregnancy, before being accepted to a temporary housing program for pregnant women. But with the loss of the twins, the housing program she’d applied to live in after giving birth — intended for families — was no longer an option.

After several weeks in a hotel, which a prenatal program for homeless people had paid for while she recovered, Davis went to a brick building in San Francisco’s South of Market neighborhood to apply for a permanent, subsidized housing unit. There, a case worker she’d never met asked her more than a dozen questions to determine if she was eligible.

Some of the things he asked: Have you ever been sexually assaulted while experiencing homelessness? Have you ever had to use violence to keep yourself safe while experiencing homelessness? Have you ever exchanged sex for a place to stay? “Those are the questions that really bothered me,” she said. “Whatever my experience is of being sexually assaulted, or what I had to do in order to stay safe on the streets, shouldn’t pertain to whether or not I deserve housing.”

That day, Davis was informed that the score she’d been given based on her answers to the questionnaire wasn’t high enough to qualify for permanent supportive housing. It was a devastating blow after an already traumatizing few months. “I thought, ‘You put me on the streets right now, mentally, I will kill myself,’” she said.

What Davis encountered with those questions is called coordinated entry, a system designed to match people experiencing homelessness with housing. In San Francisco’s system, applicants are asked 16 core questions, and their answers are given a point value which is then tallied. The total number is intended to reflect applicants’ vulnerability; currently, a score of 118 points means they qualify for one of the city’s permanent supportive housing units, which is subsidized by the government and comes with wraparound supportive services. Applicants with lower scores may qualify for rent assistance or a bus ticket out of town, but if they want housing in San Francisco, they have to wait six months before taking the test again.

Though the city’s Department of Homelessness and Supportive Housing has an annual budget of $598 million and the majority of that is spent on housing, there simply aren’t enough permanent supportive housing units available to accommodate the thousands of homeless people in San Francisco. (A 2019 survey estimated the number of homeless people at more than 8,000.) The threshold for approval is directly tied to housing availability, and right now, roughly one-third of people who take the assessment score high enough to qualify.

“It’s really prioritizing scarce resources,” said Cynthia Nagendra, the department’s deputy director of planning and strategy. “There has to be some prioritization, unfortunately, until we have some housing resource for every single person.”

Coordinated entry was meant to be a more objective tool than the previous system, which offered resources on a first-come, first-served basis. In contrast, coordinated entry aims to determine who is most vulnerable and who should therefore get access to the limited supply of available housing.

Through records requests, the San Francisco Public Press and ProPublica obtained the questions and scoring algorithm used in San Francisco’s coordinated entry questionnaire, which has never before been made public. The news organizations solicited feedback on that tool from front-line workers, academics and people experiencing homelessness. Some raised objections to how the questions were phrased. Others pointed out inequities in the scoring. And many more criticized the way it was administered, suggesting that the process itself — in which applicants are asked very personal questions by a stranger — might make it unlikely that already-distressed people would answer accurately.

In our interviews, it became clear that the survey fails to identify many of the vulnerabilities it was intended to catch. And what was supposed to be an objective tool winds up, as a result of how it’s written and administered, making it harder for certain populations — immigrants, young people and transgender people — to get indoors, experts and advocates told us.

For Davis, that meant some of the hardships she was experiencing were overlooked. For instance, there was no question in the survey that would give her points for the losses she had just suffered. Failing to qualify for housing resulted in weeks of stress and instability while she recovered from the trauma of losing her children. Eventually, with the assistance of case workers at several organizations, she found a place in a transitional housing program for youth. But being told, during the lowest moment of her life, that she did not qualify for permanent housing left its mark. “It made me feel invalid in my own experience,” she said.

In response to these critiques, homelessness department spokesperson Denny Machuca-Grebe said in an email, “I want to make it clear that anyone who comes to our department for help should NOT ‘be left out.’” For those deemed ineligible for housing, he said the city offers other services; these may include shelter placements, relocation help and rental assistance. In general, the department had not responded to requests for comments about individual cases in the past, and it didn’t comment on Davis’ experience.

Excluded Populations

Coordinated entry was first implemented in 2018, after the Department of Housing and Urban Development began requiring regions that apply for federal homelessness funds to create a tool “to ensure that people who need assistance the most can receive it in a timely manner.” Much of the rest of the country adopted a tool called the Vulnerability Index, Service Prioritization Decision Assistance Tool. San Francisco developed its own set of questions, intended to determine which unhoused people are in greatest need of a home.

In the four years since the requirement was implemented, some cities and counties have reviewed their coordinated entry systems and uncovered trends such as significant racial or gender biases. A 2019 analysis of data from Oregon, Virginia, and Washington found that even though people of color were overrepresented in the homeless population, they tended to score significantly lower than their white counterparts, making it harder for them to access permanent supportive housing. The study recommended that HUD consider revising its coordinated entry guidelines to ensure that communities“equitably allocate resources and services.” This year, San Francisco started its own analysis of its coordinated entry process, and it expects to present the findings before the end of the year.

Nearly every expert we interviewed suggested that the experiences of people of color may not be fully reflected in their answers to the coordinated entry questions. San Francisco’s own data shows Black, white, Asian and Indigenous people being approved for housing at roughly equal rates. But Nagendra, from the Department of Homelessness and Supportive Housing, is looking into concerns that conditions that often make people of color more vulnerable are not being fully captured and that the numbers may not tell the whole story. “When you look at quantitative data, ours will show we are actually prioritizing people who are Black at an equitable rate. But when we talk to people, they might tell a different story,” she said.

Courtney Cronley, an associate professor of social work at the University of Tennessee who has written about racial bias in coordinated entry systems, pointed to one of San Francisco’s questions as an example of possible bias in action: “How many times have you used crisis services in the past year (for example, mental health crisis services, hospital, detox, suicide prevention hotline)?”

“Black people are less likely to use formal health care systems,” Cronley said. “They’ll reach out to family and friends and social support systems rather than going to the doctor. The doctor is not someone that they necessarily trust. These questions are biased towards persons who are white in our communities and biased against African Americans.”

The Department of Homeslessness and Supportive Housing has also said that very few transgender and gender-nonconforming people have been taking coordinated entry assessments. In a December 2021 meeting, Megan Owens, the department’s coordinated entry manager, presented demographic data on who was being assessed. She said that the number of people reporting those gender identities during assessments is “lower than in the best estimates of the homeless population.” In March, city data showed that transgender and gender-nonconforming people constituted only 2% of those taking assessments to try to get housing.

Critics of San Francisco’s coordinated entry system also say that one of the most basic questions, “How long have you been homeless this time?” leads to the exclusion of immigrants and younger people.

That question might sound simple, but it’s difficult for many people to say how long they’ve been homeless — and answering accurately can be critical to getting housing. That’s because San Francisco’s algorithm grants people more points the longer they have been unhoused: A person who has been homeless for more than 15 years receives 12 more points than someone who’s been homeless for one to two years. Anyone who says they’ve been homeless for less than a year gets zero points on this question. (On average, adults who qualify for housing in San Francisco report being homeless for six years.)

Daniel Liévano for ProPublica

The screening tool’s 16 core questions are meant to gauge who qualifies for permanent supportive housing, but can be an impassible gauntlet for some.

Gayle Roberts, the chief development officer at Larkin Street Youth Services, a nonprofit serving young homeless people in San Francisco, said it is “common knowledge among social service providers that it [the coordinated entry system] is weighted heavily toward serving the needs of those who have experienced homelessness the longest.”

Laura Valdéz, executive director of Dolores Street Community Services, is one of several nonprofit leaders who questioned the efficacy of the system. “For many newly arrived immigrants, the way they literally interpret that question is since they’ve been here in San Francisco,” she explained. “So their scores are really low in comparison to other folks. But a large percentage of our immigrant community were unhoused in their home country.”

Valdéz also said the coordinated entry system can lead people living outdoors to accrue significant trauma before they qualify for permanent supportive housing. The program, she said, “requires people to stay in that system that is creating greater and greater harm to them for them to be able to score higher.”

The duration-of-homelessness question can also be tricky for homeless youth, defined as those between 18 and 24. In a 2019 count, they accounted for 14% of the city’s homeless population. Many young people are intermittently homeless, making it difficult to calculate the full length of that experience, said Dr. Colette Auerswald, a professor of community health sciences at the University of California, Berkeley.

“Maybe they stayed on their friend’s couch for five days and they were on a bus last night,” she said. “So they may be like, ‘Well, one day,’ but actually they’ve been in an unstable situation for a really long time.”

San Francisco’s homelessness department acknowledges this bias against young people seeking housing. In an attempt to address the age gap, the department included two questions that are only scored for people ages 18 to 24: “In the place you are staying, are you experiencing physical or sexual violence?” and, “In the last 12 months have you traded sex for a place to stay?” If they answer yes to either one, it provides a significant bump in their overall score: 12 points for each question. But if anyone older than 24 who has been sexually assaulted or has traded sex for a place to stay gets no points at all. (While the answers to these questions are only scored for 18-to-24-year-olds, they are asked of every person who takes the assessment. When asked why these questions were asked of people who could not receive points for answering, the department said it was for “data gathering.”)

Machuca-Grebe,  the department spokesperson, explained that the question was added because “we have found that without the score placed on the questions for youth, they would be seriously under prioritized — leading to a disproportionate exclusion of youth.”

Davis was in the 18-to-24 age range when she first took her coordinated entry assessment, so those questions were scored. But she does not believe they should be asked at all.

“There’s not a single person that I can think of that is female-presenting that hasn’t been sexually assaulted while experiencing any part of their life, not just homelessness,” she said. “So you’re telling me that because someone hasn’t been raped, that she doesn’t get housing, and then she stays on the streets and then does get raped? And now she can? No, that doesn’t make sense.”

Questions From a Stranger

It is not just the wording and scoring of the questions that give experts pause. They also said that the way the assessment is given can fail to accurately assess a person’s vulnerability.

In San Francisco, all questions must be read by a trained staff member from one of the nonprofits that contract with the city to conduct the assessment. The questions are pulled up on an iPad or a computer. A drop-down menu offers a prewritten set of answers to select from, and the score is automatically added up by the software.

Coordinated entry assessments are frequently conducted in semi-public places, like a bustling office or a street corner under a highway. Applicants rarely have a preexisting relationship with the person asking the questions, and, due to understaffing at many nonprofits conducting assessments and the high number of people in need, there may not be time to build one.

“You really need to have interviewers establish rapport and relationship with the client prior to conducting or doing any assessment, because if they don’t trust interviewers, they’re just not going to talk to them,” said Cronley, the University of Tennessee professor.

The stakes are high: When an interviewer chooses the “Client refused” option from the pull-down menu of potential answers, the applicant receives zero points for that question.

Valdéz also sees lack of trust as a problem in the communities she serves. “Many of us would not feel comfortable speaking about our personal traumas, in 45 minutes, to a complete stranger,” she said. “My family experienced homelessness, and I can tell you right now, if I’m sitting in front of someone that I’ve just met, it is very unlikely that I would share that in an assessment.”

This was a concern voiced by Auerswald, the Berkeley professor, about the youth questions on violence and trading sex for a place to stay. She said the phrasing would not secure accurate results.

“My worries here is that a lot of young people are gonna say no,” she said. “And obviously, here, they really need to say yes. It’s one of their only hopes at prioritizing for housing, even though it’s a super traumatizing question.”

People’s personal interpretation of each question can affect their answers, Auerswald said. “A lot of young people who are trafficked would say no to this question,” she said. “They’d say, ‘Well I wasn’t raped, it wasn’t violent. I have someone taking care of me and I am paid or given something in exchange.’ Definitions of violence are different now. Violence is a lot of things. You can have sex under threat of violence, even if you don’t have a mark on you.”

Cronley said racial bias in child welfare and policing plays a similar role in determining how forthcoming people are willing to be when answering these questions.

“Black women are going to be more likely to fear that their children will be taken away from them if they report illicit behaviors, or if they report any sort of mental health challenges,” she said. “If you’ve got kids and you’re homeless and you’ve traded sex for money, you’re not going to tell them that you did that. No way.”

Daniel Liévano for ProPublica

Critics of San Francisco’s coordinated entry assessment say it’s biased against groups like immigrants, young people and transgender people.

Davis had enough experience with systems for homeless people that she knew not answering the questions was not an option. “I had no choice but to answer them or I couldn’t get into housing,” she said.

For some, though, the experience is so uncomfortable that they drop out of the process entirely. A native of El Salvador, Luis Reyes has lived in San Francisco for 30 years and been homeless for 10 of those. Reyes said he has taken the coordinated entry questionnaire twice — once in 2019 and again in 2020, right before the pandemic hit. Like Davis, he went to the brick building at 123 10th St., the city’s largest drop-in center for these assessments.

“There was a guy who did the assessment in Spanish,” Reyes said, through an interpreter, of his 2020 interview. “‘Are you incapacitated? Are you a senior citizen? Do you have AIDS?’” Reyes remembers him asking. “He even asked me if I was gay,” he recalls — a question that is not included in the coordinated entry assessment. Reyes answered no to all of the above and says he was then told he didn’t qualify for housing.

The experience discouraged Reyes, who was living in a shelter at the time of his second assessment. He decided not to take the questionnaire again. He has spent some months sleeping in his car, and more recently he stayed with his girlfriend at a senior living facility. But she’s not allowed to have guests, and soon he will have to return to the streets.

System Under Review

Across the country, cities and counties are starting to critically examine their coordinated entry systems. Last year, eight communities, including Chicago and Austin, Texas, studied the data on their coordinated entry results and discovered significant racial disparities. Both cities revised their systems using community feedback, redesigned their processes and wound up approving more people of color for services.

In San Francisco, 17,000 coordinated entry assessments were conducted between the launch of the system in 2018 and the middle of 2021. This year, the city announced it would be undertaking its own review to determine if the government is serving people equitably and if the housing options offered are a good fit for those in need. Nagendra, at the Department of Homelessness and Supportive Housing, is overseeing the city’s review.

“If things have gotten away from our overall intention and design, we can look at those things and figure out where we need to redesign, refresh, whatever it might be,” she said in an interview.

The city’s approach to its review is driven by data and leans heavily on interviews, which are being conducted in focus groups and through outreach at encampments. The agency plans to make the research findings public in late May.

Critics would like to see a more radical overhaul of the coordinated entry system and the way it is pegged only to the supply of housing.

Joe Wilson, executive director of Hospitality House, a community center for homeless people in the Tenderloin neighborhood, where the majority of the city’s unhoused population resides, explains the problem with that approach.

“This algorithmic-based decision-making process is designed to keep the problem small enough so we don’t have to truly address it,” he said in an interview. “They’re not filling housing based on need, they’re assigning it based on capacity. It is not logical, it’s not consistent, and it’s not effective.”

For example, families used to be required to hit 40 points to qualify for housing. In February, the Department of Homelessness and Supportive Housing doubled that number to 80 points due to a shortage of family-specific housing. Owens, the coordinated entry manager at the department, estimated that the change would reduce the number of families who qualified for housing to between 50% and 60% of those taking the assessment, down from 75%.

Critics of the coordinated entry program have been proposing solutions as the city begins its review. In a February report, the Coalition on Homelessness, San Francisco’s largest nonprofit advocating for homeless people, recommended that the city “develop an assessment tool that categorizes people according to what type of housing would be the most suitable for their situation, instead of assigning them an eligibility score. This will tell us what type of housing and assistance is needed, versus how much housing we have.”

The organization also proposes letting case workers and housing providers work together to identify the best place to house an applicant. This approach, the Coalition argues, would create “a real-time housing placement system” that would more quickly bring vulnerable people indoors. This could help address the city’s chronic difficulty in filling the vacant units it has available: As the San Francisco Public Press and ProPublica reported in February, 1,633 people who had been approved for housing were still waiting to move in — some for months — even as more than 800 apartments sat vacant. At least 400 people had been on the waitlist for more than a year.

For those working on the front lines of the homelessness crisis, change to the coordinated entry system can’t come fast enough. Last July, in a meeting with the Department of Homelessness and Supportive Housing, Wilson told a story about a client his organization had helped.

“We have an 86-year-old woman who has been homeless for 14 years who has not been prioritized for housing,” he said, noting that she took a coordinated entry assessment but did not hit the 118-point threshold for housing.

A key insight from that experience, he said: Algorithmic decision-making “moves us away from the absolute necessity of human judgment and human interaction in human services.”

Read part one, In San Francisco, Hundreds of Homes for the Homeless Sit Vacant

The post San Francisco Rations Housing by Scoring Homeless Individuals’s Trauma. By Design, Most Fail to Qualify. appeared first on Los Gatos News And Events.

Did you experience any unwanted sexual attention, uninvited sexual advances, or forced sex while in the military? Does this experience continue to affect your life today?

Both women and men can experience sexual harassment or sexual assault during their military service. VA to these experiences as military sexual trauma, or MST. One in five female Veterans and 1 in 100 male Veterans have told their VA healthcare provider that they experienced MST.

MST also occurs any time the survivor isn’t able to give consent, such as while intoxicated or drugged, or when they are pressured into giving consent in exchange for promises of favorable duties or promotion, or threats of harm to their career. The perpetrator needs to be in the military for it to be considered MST.

Like other types of trauma, MST can negatively impact a person’s mental and physical health, even many years later.

Some problems associated with MST include:

• Disturbing memories or nightmares
• Feelings of depression or numbness
• Problems with alcohol or drugs
• Feeling isolated from other people
• Problems with anger or irritability
• Problems with sleep
• Physical health problems
• Avoidance or fear of medical exams or procedures

VA has special services available to help men and women who have experienced MST.

Healing from sexual trauma is possible. People can heal from trauma. To help Veterans do this, VA provides treatment for mental and physical health conditions related to experiences of MST. You do not need to be service connected and may be able to receive this benefit event if you are not eligible for other VA care. You do not need to have reported the incidents when they happened or have other documentation that they occurred.

SERVICES AVAILABLE

SFVAMC has a designated MST Coordinator who serves as a contact person for MST-related issues. This person is your advocate and can help you find and access VA services and programs and community resources.

SFVAMC has providers knowledgeable about treatment for the after-effects of MST. We offer specialized outpatient mental health services focusing on sexual trauma. VA Vet Centers also have specially trained sexual trauma counselors.

Each Community-based Outpatient Clinic (CBOC) has a designated MST contact person. Patients are welcome to call their clinic and ask to speak with the appropriate staff person listed below:

Clearlake Clinic – 707-995-7234, Aileen Camacho, MD

Downtown Clinic – 415-281-5100, Alison May, MD

Eureka Clinic – 707-269-2827, Forest Harpham, LCSW

San Bruno Clinic – 650-615-6030, Anne French, LCSW

Santa Rosa Clinic – 707-569-2300, Monica Sanchez, PhD

Ukiah Clinic – 707-468-7700, Mihaela Schneider, PsyD

Oakland Clinic – 510-587-3412, Damon Johnson, LCSW and 510-587-3459, Nicole Ward, PhD

The Veterans Crisis Line is 800-273-8255 and press 1.

For urgent needs, patients may be seen in the SFVAMC Emergency Department (always open).

For information about Mental Health treatment, please call the Psychiatric Evaluation Services at 415-221-4810, ext. 2-6674. (Service connection or disability compensation is not required to receive free treatment for conditions resulting from MST.)

The post Navy Sexual Trauma (MST) | VA San Francisco Well being Care appeared first on Los Gatos News And Events.

The morning began like most in the Saleh family’s tiny studio six floors above Turk and Hyde streets in the Tenderloin. The four children rose from their mats on the floor as their parents emerged from the closet where they shared a small mattress.

Abu Bakr Saleh, the father and sole earner in the family of refugees who fled the war in Yemen, rushed to begin a 16-hour double shift at a grocery store and a KFC. His wife, Sumaya Albadani, began an isolating day of cooking, cleaning and waiting for the others to return.

The kids — Ahmed, 16, Asma, 15, Raghad, 12, and 10-year-old Maya — rode a rickety elevator downstairs, down to one of the city’s most distressed blocks, before fanning out to their four schools.

But on Sept. 29, 2021, Raghad didn’t reach hers.

Raghad Saleh, 11, poses for a portrait on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M James/The Chronicle 2021

The sixth-grader at Francisco Middle School in North Beach — who had suffered a major trauma the year before, when an immigration fiasco forced her family to leave her with strangers in Egypt — lingered on the 400 block of Larkin Street while Ahmed ran into a shop to do an errand.

Just then, a woman in a wheelchair approached, yelling incoherently and spouting Islamophobic statements about the girl’s hijab, according to the girl and police. Raghad, still learning English, only caught portions of the diatribe, but heard three words very clearly: “Are you scared?”

“After that, she came close to me, and she hit me,” the girl told me a few months later. “She punched me in the head. I felt dizzy after that. I couldn’t believe it.”

Ahmed witnessed the attack and rushed to help. A security guard called 911. Police responded and arrested the woman on suspicion of committing assault, child endangerment and a hate crime. After getting checked out by paramedics, Raghad spent the day at home.

She hasn’t been the same since, her family said. She spends long hours playing games on her phone or watching YouTube videos. She’s listless. She cries more. She’s still fearful, saying she’s seen the suspect several times since the attack despite a protective order to stay away.

The attack was shocking, but only to a degree, in a neighborhood with one of the city’s highest assault rates. And it would ripple outward: In November, the episode would become one focus of a letter that Tenderloin families delivered to Mayor London Breed, pleading for help.

(From left to right): In this undated family photo Asma Saleh and Raghad Saleh pose for a photo in Yemen. Raghad was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year in the Tenderloin on her walk to school.

Courtesy Abu Bakr Saleh

“We are immigrants and refugees. We are children and mothers and fathers,” began the letter, penned by staff at the Tenderloin Community Benefit District and signed by 400 neighbors. “We are the Tenderloin, and you have failed us.”

The Salehs had one wish: to escape their $2,050-a-month studio for a bigger apartment in a safer neighborhood. More broadly, they sought the American dream in a city that proclaims itself a refuge.

But while San Francisco officials furiously debated what to do about a crisis of homelessness, addiction and mental illness in the Tenderloin, no one talked much about reducing harm to the many families stuck in one of the last semi-affordable stretches of the city.

In many respects, the Saleh family was living a dream life in Yemen. Abu Bakr, now 38, supported his family as an accountant for the finance ministry. Their six-bedroom home in Ibb, a city in western Yemen, was surrounded by lush gardens.

But the country’s war that began in 2014, when Houthi rebels took control of the northern part of Yemen, brought devastation. A military coalition led by Saudi Arabia and backed by the United States entered the fight, and it has dragged on since. The United Nations estimates 377,000 people have been killed, 70% of them young children. Millions more, including the Salehs, have been displaced.

Abu Bakr made it to San Francisco in 2016 to join his parents, who were already living in Mission Bay. He planned to get settled and then send for his wife and four children, who had fled to Egypt. Finally, on March 1, 2020, the family received visas to travel to the United States — all but Raghad. To this day, it’s not clear why.

Raghad Saleh’s father, Abu Bakr Saleh, stocks soft drinks during his shift at Saabis Groceries, a corner market in Bayview Hunterspoint, on Wednesday, January 26, 2022, in San Francisco, Calif. Saleh, who’s originally from Yemen, usually works six days a week, sometimes seven, and rarely sees his family. “I’m happy I bring my family here. I’m lucky because I stay with my kids. But I work too hard because (it’s) expensive here,” Sales said. “It’s too expensive here and I can’t save money and I stay in a bad location also. I work 85 hours a week. If I want to take a vacation, I can’t buy rent. No money. It’s too much. I work too hard.” Saleh’s 11-year-old daughter, Raghad, was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was recently attacked by a stranger on her walk to school.

Yalonda M. James/The Chronicle

As they waited, they faced a deadline — the July 1 expiration date of the visas — and a pandemic obstacle: The Trump administration suspended visa services at all U.S. embassies and consulates in March 2020 and, in June, banned most immigration to the U.S. through the end of the year.

So Sumaya and her other children made the excruciating decision to fly to San Francisco while they still could, depositing Raghad with a Yemeni family in Cairo they barely knew.

“All the time in the airplane,” Sumaya recalled, “I was crying because I left my daughter.”

The Saleh family became one of 23 plaintiffs challenging Trump’s immigration restrictions in court. The Chronicle told their story on July 29, 2020, and the next month, the U.S. Embassy in Cairo granted Raghad — who’d been stranded for six weeks — a visa.

But their new life was far from what they had envisioned.

“Thank you, my God, to bring my family here,” Abu Bakr said. “I’m happy I’m here because it’s too much problem in Yemen. No salary, no power, no water, no food. It’s war. But I work too hard because it’s expensive here, you know? I can’t save money, and I stay in a bad location also.”

Raghad Saleh (center) pulls off her mask and smiles at her family moments after she arrived at San Francisco International from Egypt. Raghad had been separated from the family due to a visa issue.

Gabrielle Lurie/The Chronicle 2020

Walking a few blocks with Raghad one day last December, from a Muni stop to her home, I saw what her dad meant. We strolled past a strip club with the sign “Where the Wild Girls Are.” Past people slumped unconscious in bus shelters. Past a woman screaming gibberish. Past a woman doing drugs on the sidewalk, her face bloodied. Past piles of trash and feces.

“This neighborhood is so scary,” Raghad said, moving quickly and nervously adjusting her hijab.

At night, the family doesn’t leave their studio. Still, they have trouble sleeping with the sounds of gunshots, fights and sirens.

“We don’t go to the window in case the gun comes,” said Maya, holding her fingers in the shape of a pistol.

Sumaya, speaking Arabic through an interpreter, said she was shocked when her picture of America didn’t match the reality of her new home. “From the pictures, I thought it would be really clean and now, when I walk up the street, it’s really, really painful to see all these things,” she said.

“If you walk a little bit far away from here,” Sumaya added, “You can say, ‘Yes, this is the United States I know.’”

Raghad Saleh, 11, left, crosses the street with close friends Maison, 12, center, and Hager, 12, as they head home after attending classes at Francisco Middle School on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle 2021

More than two months after Raghad was attacked, her mother brought her and her brother to a mid-December meeting with Breed in the city’s main library to discuss conditions in the Tenderloin. The mayor barred journalists, but according to an audience member’s recording, she told the families she was frustrated by the neighborhood’s “horrible conditions.”

“You’re dealing with the concern of whether you might get robbed or hit over the head or attacked or spit on,” Breed told them.

People in the audience said the city was looking the other way as drug dealers created misery. And that cops just drove past rather than walking the beat. Several shared stories about their businesses being robbed, strangers attacking them, hate crimes proliferating and being forced to huddle with children at playgrounds as men brandished guns outside the gates.

Breed promised big changes. She would deploy more officers to the Tenderloin like she had in Union Square after the looting of Louis Vuitton and other luxury stores weeks before.

After the meeting, Raghad said she was upset she didn’t get to share her story of being attacked before the mayor abruptly left. “There are a lot of people who are struggling in this area and facing the same problem I did,” she said.

But the family was encouraged. The mayor had promised help.

Raghad Saleh, 11, right, holds the hand of her close friend Maison, 12, left, as they ride the bus following classes at Francisco Middle School on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle 2021

Four days later, Breed assembled the news media at City Hall to announce a state of emergency in the Tenderloin meant to end “all the bulls— that has destroyed our city.” She said residents would see far more police and that they’d crack down on drug dealing, gun violence and the resale of stolen goods.

But that pledge of a Union Square-like police presence in the Tenderloin never materialized. More officers came months later — Breed said the delay owed to understaffing and the omicron virus — and only during the day.

Drug dealing continued unabated, signaling that purveyors of fancy handbags were more important to the city than low-income families like the Salehs who were left to deal with the fallout.

The family occasionally witnessed overdoses from their window. After Maya started talking about seeing “dizzy” people “laying on the floor,” it became clear she meant people passed out on the sidewalks after using drugs.

“Everybody is scared here,” Maya said. “If I walk with myself, my brain says, ‘Maya, don’t be scared.’ Everything will be OK.”

Raghad Saleh, 11, right, eats a meal with her mother, Sumaya Saleh, 39, and her sister, Maya Saleh, 10, in their Tenderloin apartment on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M James/The Chronicle

Though Raghad’s visa crisis was unique, her family’s path from Yemen to the Tenderloin was not.

Jehan Hakim, chair of the Yemeni Alliance Committee, a group calling on the United States to cease military involvement in Yemen, said her father moved her family here in the mid-1970s in pursuit of better education and more opportunities.

Word of mouth brought more families from Yemen, and eventually hundreds settled in two low-income buildings on Turk and Jones streets. Today, there are two mosques in the neighborhood and a community group that provides immigration help, but almost no other services specifically for Yemeni immigrants, Hakim said.

“We don’t have anything with wrap-around social services that’s focusing on supporting Arab people coming from other countries,” she said.

Aseel Fara, a 22-year-old outreach coordinator at the Tenderloin Community Benefit District, said the Saleh family’s story sounded like his own. When his family left Yemen, they packed into a studio apartment on the same block as the Salehs, lured by the cheapest possible rent in the city.

“We’re limited to areas such as the Tenderloin,” Fara said, “which are neglected by the city and neglected by society.”

There’s no good data on how many Yemeni people live in the Tenderloin — Arab people are supposed to mark themselves as white in the U.S. census — but Hakim guesses as many as 2,500 live in the neighborhood now.

Raghad Saleh, 11, listens to instructions from her music teacher Flora Wong as she sits by her piano during class at Francisco Middle School on Friday, January 7, 2022, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

Even the richest families from Yemen are poor in San Francisco, Fara said, because any money they’ve saved buys so little here, and their education and work experience back home counts for next to nothing. Men from Yemen who settle in the Tenderloin often work as janitors or grocery store clerks, he said, and the women often stay home alone during the school day.

Moving from a conservative Muslim country to the anything-goes Tenderloin can be shocking, Fara said. And it can be frightening for women to walk the streets in hijabs, which sometimes draw stares and bigoted remarks.

But despite the hardships, Fara is glad his family moved to San Francisco.

“I don’t want to take away from what America has provided us,” he said. “The opportunities are endless.”

And indeed, the Saleh children have their dreams.

Ahmed, who goes to Galileo High, told me he wants to study computer science and work as a web developer. Asma, in a program at SF International High designed for recent immigrants, hopes to be an interpreter and plans to tackle Spanish after perfecting her English. Maya, a bright-eyed girl who attends Tenderloin Community Elementary, imagines becoming a doctor.

Raghad, rarely as animated as her siblings, said she isn’t sure what her future will bring. She acknowledged she still feels depressed. She went to the counseling office at school once, but said the social worker wasn’t there, and she never tried again.

“Sometimes I dream my house from Yemen is here in the USA,” Raghad said, explaining this would be the best of both worlds.

Raghad Saleh’s sister, Maya Saleh, 10, converses with Urban Alchemy ambassador Aaron Trujillo as she returns home from school, at Turk and Hyde, in the Tenderloin on Friday, February 11, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

About six weeks after Breed declared her Tenderloin emergency, the Salehs told me they felt their block was a little safer and cleaner, partly thanks to ambassadors from Urban Alchemy, the nonprofit group hired by San Francisco to calm the city’s troubled core.

The blocks to the north seemed worse, so they often walked south instead — to the fields and playgrounds in Civic Center Plaza.

“Sometimes I feel sad,” Abu Bakr said, sitting on a bench during a rare day off as his daughters played. “I worry too much. I can’t save more. I can’t see my children.”

Ahmed, sitting at his father’s feet, said he’d told one of the mayor’s staff members at the library meeting about Raghad’s attack — and the family’s wish to leave the Tenderloin — but that no help had come through.

After I started asking questions, the Mayor’s Office and District Attorney’s Office pledged housing and mental health assistance for the Salehs. But eight months after the attack, none has materialized.

Finding publicly funded therapists taking new clients has proved difficult due to pandemic-fueled waiting lists, and finding an Arabic-speaking therapist is nearly impossible, explained Kasie Lee, chief of the D.A.’s Victim Services Division. The office was able to locate an Arabic-speaking therapist in private practice and is trying to secure money to pay for sessions, but Raghad still hasn’t talked to a professional about her trauma.

Obtaining a new apartment is also difficult. Lee explained that relocation assistance from the District Attorney’s Office and a state victim’s compensation fund would typically help the family cover a security deposit and first month’s rent. The problem is finding a larger, safer apartment the family can afford, long-term, on its own. The family can apply for affordable housing programs, but the wait lists are notoriously long.

Raghad Saleh, 11, right, hugs her sister Asma Saleh, 14, as they hang out at Civic Center Plaza on Saturday, January 29, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was recently attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle

Moving out of the city proved daunting since the family had no car and no job lined up elsewhere and couldn’t easily scrape together moving expenses.

Nothing much has happened in the case of Raghad’s alleged attacker. District Attorney Chesa Boudin charged Tinesha Scott, 48, with felony child endangerment and felony assault with a hate crime enhancement.

Boudin’s spokesperson, Rachel Marshall, said the office filed a motion to detain Scott, but a Superior Court judge denied it. The courts issued a criminal protective order, but Raghad said she has seen Scott several times since the encounter — including beneath her studio window. She said she was terrified when Scott waved at her.

“Next time,” Raghad said, “she could be holding a knife.”

Phoenix Streets, a public defender representing Scott, said his client had experienced a mental health crisis that September morning and received care at a hospital. Eight months after the attack, Scott has not received long-term treatment, which Streets blamed on “the underfunding of our mental health care system.”

And so, all these months later, everybody involved remains in pretty much the same position: The Saleh family stuck in a tiny studio on a ragged block. Raghad anxious and scared. Scott’s mental illness unaddressed. The city of San Francisco seemingly no closer to helping the families of the Tenderloin — which is no longer in a state of emergency, at least officially.

But there is one big change: Sumaya is expecting her fifth baby — a boy — in September. He’s one more reason to find a bigger apartment. One more reason to strive for a better life. One more reason to dream.

(From left to right): Maya Saleh, 10, Abu Saleh, 37, Asma Saleh, 15, Raghad Saleh, 12, and Ahmed Saleh, 16, pose for a portrait in their small studio Tenderloin apartment on Sunday, April 3, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

Heather Knight is a San Francisco Chronicle columnist. Email: hknight@sfchronicle.com Twitter: @hknightsf

The post A woman fled her war-torn homeland, however discovered extra trauma in San Francisco appeared first on Los Gatos News And Events.

The morning began like most in the Saleh family’s tiny studio six floors above Turk and Hyde streets in the Tenderloin. The four children rose from their mats on the floor as their parents emerged from the closet where they shared a small mattress.

Abu Bakr Saleh, the father and sole earner in the family of refugees who fled the war in Yemen, rushed to begin a 16-hour double shift at a grocery store and a KFC. His wife, Sumaya Albadani, began an isolating day of cooking, cleaning and waiting for the others to return.

The kids — Ahmed, 16, Asma, 15, Raghad, 12, and 10-year-old Maya — rode a rickety elevator downstairs, down to one of the city’s most distressed blocks, before fanning out to their four schools.

But on Sept. 29, 2021, Raghad didn’t reach hers.

The sixth-grader at Francisco Middle School in North Beach — who had suffered a major trauma the year before, when an immigration fiasco forced her family to leave her with strangers in Egypt — lingered on the 400 block of Larkin Street while Ahmed ran into a shop to do an errand.

Just then, a woman in a wheelchair approached, yelling incoherently and spouting Islamophobic statements about the girl’s hijab, according to the girl and police. Raghad, still learning English, only caught portions of the diatribe, but heard three words very clearly: “Are you scared?”

Raghad Saleh, 11, poses for a portrait on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M James/The Chronicle 2021

“After that, she came close to me, and she hit me,” the girl told me a few months later. “She punched me in the head. I felt dizzy after that. I couldn’t believe it.”

Ahmed witnessed the attack and rushed to help. A security guard called 911. Police responded and arrested the woman on suspicion of committing assault, child endangerment and a hate crime. After getting checked out by paramedics, Raghad spent the day at home.

She hasn’t been the same since, her family said. She spends long hours playing games on her phone or watching YouTube videos. She’s listless. She cries more. She’s still fearful, saying she’s seen the suspect several times since the attack despite a protective order to stay away.

The attack was shocking, but only to a degree, in a neighborhood with one of the city’s highest assault rates. And it would ripple outward: In November, the episode would become one focus of a letter that Tenderloin families delivered to Mayor London Breed, pleading for help.

(From left to right): In this undated family photo Asma Saleh and Raghad Saleh pose for a photo in Yemen. Raghad was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year in the Tenderloin on her walk to school.

Photo Courtesy Abu Bakr Saleh/The Chronicle

“We are immigrants and refugees. We are children and mothers and fathers,” began the letter, penned by staff at the Tenderloin Community Benefit District and signed by 400 neighbors. “We are the Tenderloin, and you have failed us.”

The Salehs had one wish: to escape their $2,050-a-month studio for a bigger apartment in a safer neighborhood. More broadly, they sought the American dream in a city that proclaims itself a refuge.

But while San Francisco officials furiously debated what to do about a crisis of homelessness, addiction and mental illness in the Tenderloin, no one talked much about reducing harm to the many families stuck in one of the last semi-affordable stretches of the city.

In many respects, the Saleh family was living a dream life in Yemen. Abu Bakr, now 38, supported his family as an accountant for the finance ministry. Their six-bedroom home in Ibb, a city in western Yemen, was surrounded by lush gardens.

But the country’s war that began in 2014, when Houthi rebels took control of the northern part of Yemen, brought devastation. A military coalition led by Saudi Arabia and backed by the United States entered the fight, and it has dragged on since. The United Nations estimates 377,000 people have been killed, 70% of them young children. Millions more, including the Salehs, have been displaced.

Abu Bakr made it to San Francisco in 2016 to join his parents, who were already living in Mission Bay. He planned to get settled and then send for his wife and four children, who had fled to Egypt. Finally, on March 1, 2020, the family received visas to travel to the United States — all but Raghad. To this day, it’s not clear why.

Raghad Saleh’s father, Abu Bakr Saleh, stocks soft drinks during his shift at Saabis Groceries, a corner market in Bayview Hunterspoint, on Wednesday, January 26, 2022, in San Francisco, Calif. Saleh, who’s originally from Yemen, usually works six days a week, sometimes seven, and rarely sees his family. “I’m happy I bring my family here. I’m lucky because I stay with my kids. But I work too hard because (it’s) expensive here,” Sales said. “It’s too expensive here and I can’t save money and I stay in a bad location also. I work 85 hours a week. If I want to take a vacation, I can’t buy rent. No money. It’s too much. I work too hard.” Saleh’s 11-year-old daughter, Raghad, was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was recently attacked by a stranger on her walk to school.

Yalonda M. James/The Chronicle

As they waited, they faced a deadline — the July 1 expiration date of the visas — and a pandemic obstacle: The Trump administration suspended visa services at all U.S. embassies and consulates in March 2020 and, in June, banned most immigration to the U.S. through the end of the year.

So Sumaya and her other children made the excruciating decision to fly to San Francisco while they still could, depositing Raghad with a Yemeni family in Cairo they barely knew.

“All the time in the airplane,” Sumaya recalled, “I was crying because I left my daughter.”

The Saleh family became one of 23 plaintiffs challenging Trump’s immigration restrictions in court. The Chronicle told their story on July 29, 2020, and the next month, the U.S. Embassy in Cairo granted Raghad — who’d been stranded for six weeks — a visa.

But their new life was far from what they had envisioned.

“Thank you, my God, to bring my family here,” Abu Bakr said. “I’m happy I’m here because it’s too much problem in Yemen. No salary, no power, no water, no food. It’s war. But I work too hard because it’s expensive here, you know? I can’t save money, and I stay in a bad location also.”

Raghad Saleh (center) pulls off her mask and smiles at her family moments after she arrived at San Francisco International from Egypt. Raghad had been separated from the family due to a visa issue.

Gabrielle Lurie/The Chronicle 2020

Walking a few blocks with Raghad one day last December, from a Muni stop to her home, I saw what her dad meant. We strolled past a strip club with the sign “Where the Wild Girls Are.” Past people slumped unconscious in bus shelters. Past a woman screaming gibberish. Past a woman doing drugs on the sidewalk, her face bloodied. Past piles of trash and feces.

“This neighborhood is so scary,” Raghad said, moving quickly and nervously adjusting her hijab.

At night, the family doesn’t leave their studio. Still, they have trouble sleeping with the sounds of gunshots, fights and sirens.

“We don’t go to the window in case the gun comes,” said Maya, holding her fingers in the shape of a pistol.

Sumaya, speaking Arabic through an interpreter, said she was shocked when her picture of America didn’t match the reality of her new home. “From the pictures, I thought it would be really clean and now, when I walk up the street, it’s really, really painful to see all these things,” she said.

“If you walk a little bit far away from here,” Sumaya added, “You can say, ‘Yes, this is the United States I know.’”

Raghad Saleh, 11, left, crosses the street with close friends Maison, 12, center, and Hager, 12, as they head home after attending classes at Francisco Middle School on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle 2021

More than two months after Raghad was attacked, her mother brought her and her brother to a mid-December meeting with Breed in the city’s main library to discuss conditions in the Tenderloin. The mayor barred journalists, but according to an audience member’s recording, she told the families she was frustrated by the neighborhood’s “horrible conditions.”

“You’re dealing with the concern of whether you might get robbed or hit over the head or attacked or spit on,” Breed told them.

People in the audience said the city was looking the other way as drug dealers created misery. And that cops just drove past rather than walking the beat. Several shared stories about their businesses being robbed, strangers attacking them, hate crimes proliferating and being forced to huddle with children at playgrounds as men brandished guns outside the gates.

Breed promised big changes. She would deploy more officers to the Tenderloin like she had in Union Square after the looting of Louis Vuitton and other luxury stores weeks before.

After the meeting, Raghad said she was upset she didn’t get to share her story of being attacked before the mayor abruptly left. “There are a lot of people who are struggling in this area and facing the same problem I did,” she said.

But the family was encouraged. The mayor had promised help.

Raghad Saleh, 11, right, holds the hand of her close friend Maison, 12, left, as they ride the bus following classes at Francisco Middle School on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle 2021

Four days later, Breed assembled the news media at City Hall to announce a state of emergency in the Tenderloin meant to end “all the bulls— that has destroyed our city.” She said residents would see far more police and that they’d crack down on drug dealing, gun violence and the resale of stolen goods.

But that pledge of a Union Square-like police presence in the Tenderloin never materialized. More officers came months later — Breed said the delay owed to understaffing and the omicron virus — and only during the day.

Drug dealing continued unabated, signaling that purveyors of fancy handbags were more important to the city than low-income families like the Salehs who were left to deal with the fallout.

The family occasionally witnessed overdoses from their window. After Maya started talking about seeing “dizzy” people “laying on the floor,” it became clear she meant people passed out on the sidewalks after using drugs.

“Everybody is scared here,” Maya said. “If I walk with myself, my brain says, ‘Maya, don’t be scared.’ Everything will be OK.”

Raghad Saleh, 11, right, eats a meal with her mother, Sumaya Saleh, 39, and her sister, Maya Saleh, 10, in their Tenderloin apartment on Wednesday, December 8, 2021, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger several weeks ago on her walk to school.

Yalonda M James/

Though Raghad’s visa crisis was unique, her family’s path from Yemen to the Tenderloin was not.

Jehan Hakim, chair of the Yemeni Alliance Committee, a group calling on the United States to cease military involvement in Yemen, said her father moved her family here in the mid-1970s in pursuit of better education and more opportunities.

Word of mouth brought more families from Yemen, and eventually hundreds settled in two low-income buildings on Turk and Jones streets. Today, there are two mosques in the neighborhood and a community group that provides immigration help, but almost no other services specifically for Yemeni immigrants, Hakim said.

“We don’t have anything with wrap-around social services that’s focusing on supporting Arab people coming from other countries,” she said.

Aseel Fara, a 22-year-old outreach coordinator at the Tenderloin Community Benefit District, said the Saleh family’s story sounded like his own. When his family left Yemen, they packed into a studio apartment on the same block as the Salehs, lured by the cheapest possible rent in the city.

“We’re limited to areas such as the Tenderloin,” Fara said, “which are neglected by the city and neglected by society.”

There’s no good data on how many Yemeni people live in the Tenderloin — Arab people are supposed to mark themselves as white in the U.S. census — but Hakim guesses as many as 2,500 live in the neighborhood now.

Raghad Saleh, 11, listens to instructions from her music teacher Flora Wong as she sits by her piano during class at Francisco Middle School on Friday, January 7, 2022, in San Francisco, Calif. Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

Even the richest families from Yemen are poor in San Francisco, Fara said, because any money they’ve saved buys so little here, and their education and work experience back home counts for next to nothing. Men from Yemen who settle in the Tenderloin often work as janitors or grocery store clerks, he said, and the women often stay home alone during the school day.

Moving from a conservative Muslim country to the anything-goes Tenderloin can be shocking, Fara said. And it can be frightening for women to walk the streets in hijabs, which sometimes draw stares and bigoted remarks.

But despite the hardships, Fara is glad his family moved to San Francisco.

“I don’t want to take away from what America has provided us,” he said. “The opportunities are endless.”

And indeed, the Saleh children have their dreams.

Ahmed, who goes to Galileo High, told me he wants to study computer science and work as a web developer. Asma, in a program at SF International High designed for recent immigrants, hopes to be an interpreter and plans to tackle Spanish after perfecting her English. Maya, a bright-eyed girl who attends Tenderloin Community Elementary, imagines becoming a doctor.

Raghad, rarely as animated as her siblings, said she isn’t sure what her future will bring. She acknowledged she still feels depressed. She went to the counseling office at school once, but said the social worker wasn’t there, and she never tried again.

“Sometimes I dream my house from Yemen is here in the USA,” Raghad said, explaining this would be the best of both worlds.

Raghad Saleh’s sister, Maya Saleh, 10, converses with Urban Alchemy ambassador Aaron Trujillo as she returns home from school, at Turk and Hyde, in the Tenderloin on Friday, February 11, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

About six weeks after Breed declared her Tenderloin emergency, the Salehs told me they felt their block was a little safer and cleaner, partly thanks to ambassadors from Urban Alchemy, the nonprofit group hired by San Francisco to calm the city’s troubled core.

The blocks to the north seemed worse, so they often walked south instead — to the fields and playgrounds in Civic Center Plaza.

“Sometimes I feel sad,” Abu Bakr said, sitting on a bench during a rare day off as his daughters played. “I worry too much. I can’t save more. I can’t see my children.”

Ahmed, sitting at his father’s feet, said he’d told one of the mayor’s staff members at the library meeting about Raghad’s attack — and the family’s wish to leave the Tenderloin — but that no help had come through.

After I started asking questions, the Mayor’s Office and District Attorney’s Office pledged housing and mental health assistance for the Salehs. But eight months after the attack, none has materialized.

Finding publicly funded therapists taking new clients has proved difficult due to pandemic-fueled waiting lists, and finding an Arabic-speaking therapist is nearly impossible, explained Kasie Lee, chief of the D.A.’s Victim Services Division. The office was able to locate an Arabic-speaking therapist in private practice and is trying to secure money to pay for sessions, but Raghad still hasn’t talked to a professional about her trauma.

Obtaining a new apartment is also difficult. Lee explained that relocation assistance from the District Attorney’s Office and a state victim’s compensation fund would typically help the family cover a security deposit and first month’s rent. The problem is finding a larger, safer apartment the family can afford, long-term, on its own. The family can apply for affordable housing programs, but the wait lists are notoriously long.

Raghad Saleh, 11, right, hugs her sister Asma Saleh, 14, as they hang out at Civic Center Plaza on Saturday, January 29, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was recently attacked by a stranger several weeks ago on her walk to school.

Yalonda M. James/The Chronicle

Moving out of the city proved daunting since the family had no car and no job lined up elsewhere and couldn’t easily scrape together moving expenses.

Nothing much has happened in the case of Raghad’s alleged attacker. District Attorney Chesa Boudin charged Tinesha Scott, 48, with felony child endangerment and felony assault with a hate crime enhancement.

Boudin’s spokesperson, Rachel Marshall, said the office filed a motion to detain Scott, but a Superior Court judge denied it. The courts issued a criminal protective order, but Raghad said she has seen Scott several times since the encounter — including beneath her studio window. She said she was terrified when Scott waved at her.

“Next time,” Raghad said, “she could be holding a knife.”

Phoenix Streets, a public defender representing Scott, said his client had experienced a mental health crisis that September morning and received care at a hospital. Eight months after the attack, Scott has not received long-term treatment, which Streets blamed on “the underfunding of our mental health care system.”

And so, all these months later, everybody involved remains in pretty much the same position: The Saleh family stuck in a tiny studio on a ragged block. Raghad anxious and scared. Scott’s mental illness unaddressed. The city of San Francisco seemingly no closer to helping the families of the Tenderloin — which is no longer in a state of emergency, at least officially.

But there is one big change: Sumaya is expecting her fifth baby — a boy — in September. He’s one more reason to find a bigger apartment. One more reason to strive for a better life. One more reason to dream.

(From left to right): Maya Saleh, 10, Abu Saleh, 37, Asma Saleh, 15, Raghad Saleh, 12, and Ahmed Saleh, 16, pose for a portrait in their small studio Tenderloin apartment on Sunday, April 3, 2022, in San Francisco, Calif. Raghad Saleh was stuck in Egypt in 2020 when her family moved to San Francisco from Yemen due to Visa problems. She was attacked by a stranger last year on her walk to school.

Yalonda M. James/The Chronicle

Heather Knight is a San Francisco Chronicle columnist. Email: hknight@sfchronicle.com Twitter: @hknightsf

The post A lady fled her war-torn homeland, however discovered extra trauma in San Francisco appeared first on Los Gatos News And Events.

Co-published with ProPublica. This article was produced for ProPublica’s Local Reporting Network in partnership with the San Francisco Public Press. Sign up for the Public Press newsletter and ProPublica’s Dispatches to get stories like this one as soon as they are published.

Tabitha Davis had just lost twins in childbirth and was facing homelessness. The 23-year-old had slept on friends’ floors for the first seven months of her pregnancy, before being accepted to a temporary housing program for pregnant women. But with the loss of the twins, the housing program she’d applied to live in after giving birth — intended for families — was no longer an option.

After several weeks in a hotel, which a prenatal program for homeless people had paid for while she recovered, Davis went to a brick building in San Francisco’s South of Market neighborhood to apply for a permanent, subsidized housing unit. There, a case worker she’d never met asked her more than a dozen questions to determine if she was eligible.

Some of the things he asked: Have you ever been sexually assaulted while experiencing homelessness? Have you ever had to use violence to keep yourself safe while experiencing homelessness? Have you ever exchanged sex for a place to stay? “Those are the questions that really bothered me,” she said. “Whatever my experience is of being sexually assaulted, or what I had to do in order to stay safe on the streets, shouldn’t pertain to whether or not I deserve housing.”

That day, Davis was informed that the score she’d been given based on her answers to the questionnaire wasn’t high enough to qualify for permanent supportive housing. It was a devastating blow after an already traumatizing few months. “I thought, ‘You put me on the streets right now, mentally, I will kill myself,’” she said.

What Davis encountered with those questions is called coordinated entry, a system designed to match people experiencing homelessness with housing. In San Francisco’s system, applicants are asked 16 core questions, and their answers are given a point value which is then tallied. The total number is intended to reflect applicants’ vulnerability; currently, a score of 118 points means they qualify for one of the city’s permanent supportive housing units, which is subsidized by the government and comes with wraparound supportive services. Applicants with lower scores may qualify for rent assistance or a bus ticket out of town, but if they want housing in San Francisco, they have to wait six months before taking the test again.

Though the city’s Department of Homelessness and Supportive Housing has an annual budget of $598 million and the majority of that is spent on housing, there simply aren’t enough permanent supportive housing units available to accommodate the thousands of homeless people in San Francisco. (A 2019 survey estimated the number of homeless people at more than 8,000.) The threshold for approval is directly tied to housing availability, and right now, roughly one-third of people who take the assessment score high enough to qualify.

“It’s really prioritizing scarce resources,” said Cynthia Nagendra, the department’s deputy director of planning and strategy. “There has to be some prioritization, unfortunately, until we have some housing resource for every single person.”

Coordinated entry was meant to be a more objective tool than the previous system, which offered resources on a first-come, first-served basis. In contrast, coordinated entry aims to determine who is most vulnerable and who should therefore get access to the limited supply of available housing.

Through records requests, the San Francisco Public Press and ProPublica obtained the questions and scoring algorithm used in San Francisco’s coordinated entry questionnaire, which has never before been made public. The news organizations solicited feedback on that tool from front-line workers, academics and people experiencing homelessness. Some raised objections to how the questions were phrased. Others pointed out inequities in the scoring. And many more criticized the way it was administered, suggesting that the process itself — in which applicants are asked very personal questions by a stranger — might make it unlikely that already-distressed people would answer accurately.

In our interviews, it became clear that the survey fails to identify many of the vulnerabilities it was intended to catch. And what was supposed to be an objective tool winds up, as a result of how it’s written and administered, making it harder for certain populations — immigrants, young people and transgender people — to get indoors, experts and advocates told us.

For Davis, that meant some of the hardships she was experiencing were overlooked. For instance, there was no question in the survey that would give her points for the losses she had just suffered. Failing to qualify for housing resulted in weeks of stress and instability while she recovered from the trauma of losing her children. Eventually, with the assistance of case workers at several organizations, she found a place in a transitional housing program for youth. But being told, during the lowest moment of her life, that she did not qualify for permanent housing left its mark. “It made me feel invalid in my own experience,” she said.

In response to these critiques, homelessness department spokesperson Denny Machuca-Grebe said in an email, “I want to make it clear that anyone who comes to our department for help should NOT ‘be left out.’” For those deemed ineligible for housing, he said the city offers other services; these may include shelter placements, relocation help and rental assistance. In general, the department had not responded to requests for comments about individual cases in the past, and it didn’t comment on Davis’ experience.

Excluded Populations

Coordinated entry was first implemented in 2018, after the Department of Housing and Urban Development began requiring regions that apply for federal homelessness funds to create a tool “to ensure that people who need assistance the most can receive it in a timely manner.” Much of the rest of the country adopted a tool called the Vulnerability Index, Service Prioritization Decision Assistance Tool. San Francisco developed its own set of questions, intended to determine which unhoused people are in greatest need of a home.

In the four years since the requirement was implemented, some cities and counties have reviewed their coordinated entry systems and uncovered trends such as significant racial or gender biases. A 2019 analysis of data from Oregon, Virginia, and Washington found that even though people of color were overrepresented in the homeless population, they tended to score significantly lower than their white counterparts, making it harder for them to access permanent supportive housing. The study recommended that HUD consider revising its coordinated entry guidelines to ensure that communities“equitably allocate resources and services.” This year, San Francisco started its own analysis of its coordinated entry process, and it expects to present the findings before the end of the year.

Nearly every expert we interviewed suggested that the experiences of people of color may not be fully reflected in their answers to the coordinated entry questions. San Francisco’s own data shows Black, white, Asian and Indigenous people being approved for housing at roughly equal rates. But Nagendra, from the Department of Homelessness and Supportive Housing, is looking into concerns that conditions that often make people of color more vulnerable are not being fully captured and that the numbers may not tell the whole story. “When you look at quantitative data, ours will show we are actually prioritizing people who are Black at an equitable rate. But when we talk to people, they might tell a different story,” she said.

Courtney Cronley, an associate professor of social work at the University of Tennessee who has written about racial bias in coordinated entry systems, pointed to one of San Francisco’s questions as an example of possible bias in action: “How many times have you used crisis services in the past year (for example, mental health crisis services, hospital, detox, suicide prevention hotline)?”

“Black people are less likely to use formal health care systems,” Cronley said. “They’ll reach out to family and friends and social support systems rather than going to the doctor. The doctor is not someone that they necessarily trust. These questions are biased towards persons who are white in our communities and biased against African Americans.”

The Department of Homeslessness and Supportive Housing has also said that very few transgender and gender-nonconforming people have been taking coordinated entry assessments. In a December 2021 meeting, Megan Owens, the department’s coordinated entry manager, presented demographic data on who was being assessed. She said that the number of people reporting those gender identities during assessments is “lower than in the best estimates of the homeless population.” In March, city data showed that transgender and gender-nonconforming people constituted only 2% of those taking assessments to try to get housing.

Critics of San Francisco’s coordinated entry system also say that one of the most basic questions, “How long have you been homeless this time?” leads to the exclusion of immigrants and younger people.

That question might sound simple, but it’s difficult for many people to say how long they’ve been homeless — and answering accurately can be critical to getting housing. That’s because San Francisco’s algorithm grants people more points the longer they have been unhoused: A person who has been homeless for more than 15 years receives 12 more points than someone who’s been homeless for one to two years. Anyone who says they’ve been homeless for less than a year gets zero points on this question. (On average, adults who qualify for housing in San Francisco report being homeless for six years.)

Daniel Liévano for ProPublica

The screening tool’s 16 core questions are meant to gauge who qualifies for permanent supportive housing, but can be an impassible gauntlet for some.

Gayle Roberts, the chief development officer at Larkin Street Youth Services, a nonprofit serving young homeless people in San Francisco, said it is “common knowledge among social service providers that it [the coordinated entry system] is weighted heavily toward serving the needs of those who have experienced homelessness the longest.”

Laura Valdéz, executive director of Dolores Street Community Services, is one of several nonprofit leaders who questioned the efficacy of the system. “For many newly arrived immigrants, the way they literally interpret that question is since they’ve been here in San Francisco,” she explained. “So their scores are really low in comparison to other folks. But a large percentage of our immigrant community were unhoused in their home country.”

Valdéz also said the coordinated entry system can lead people living outdoors to accrue significant trauma before they qualify for permanent supportive housing. The program, she said, “requires people to stay in that system that is creating greater and greater harm to them for them to be able to score higher.”

The duration-of-homelessness question can also be tricky for homeless youth, defined as those between 18 and 24. In a 2019 count, they accounted for 14% of the city’s homeless population. Many young people are intermittently homeless, making it difficult to calculate the full length of that experience, said Dr. Colette Auerswald, a professor of community health sciences at the University of California, Berkeley.

“Maybe they stayed on their friend’s couch for five days and they were on a bus last night,” she said. “So they may be like, ‘Well, one day,’ but actually they’ve been in an unstable situation for a really long time.”

San Francisco’s homelessness department acknowledges this bias against young people seeking housing. In an attempt to address the age gap, the department included two questions that are only scored for people ages 18 to 24: “In the place you are staying, are you experiencing physical or sexual violence?” and, “In the last 12 months have you traded sex for a place to stay?” If they answer yes to either one, it provides a significant bump in their overall score: 12 points for each question. But if anyone older than 24 who has been sexually assaulted or has traded sex for a place to stay gets no points at all. (While the answers to these questions are only scored for 18-to-24-year-olds, they are asked of every person who takes the assessment. When asked why these questions were asked of people who could not receive points for answering, the department said it was for “data gathering.”)

Machuca-Grebe,  the department spokesperson, explained that the question was added because “we have found that without the score placed on the questions for youth, they would be seriously under prioritized — leading to a disproportionate exclusion of youth.”

Davis was in the 18-to-24 age range when she first took her coordinated entry assessment, so those questions were scored. But she does not believe they should be asked at all.

“There’s not a single person that I can think of that is female-presenting that hasn’t been sexually assaulted while experiencing any part of their life, not just homelessness,” she said. “So you’re telling me that because someone hasn’t been raped, that she doesn’t get housing, and then she stays on the streets and then does get raped? And now she can? No, that doesn’t make sense.”

Questions From a Stranger

It is not just the wording and scoring of the questions that give experts pause. They also said that the way the assessment is given can fail to accurately assess a person’s vulnerability.

In San Francisco, all questions must be read by a trained staff member from one of the nonprofits that contract with the city to conduct the assessment. The questions are pulled up on an iPad or a computer. A drop-down menu offers a prewritten set of answers to select from, and the score is automatically added up by the software.

Coordinated entry assessments are frequently conducted in semi-public places, like a bustling office or a street corner under a highway. Applicants rarely have a preexisting relationship with the person asking the questions, and, due to understaffing at many nonprofits conducting assessments and the high number of people in need, there may not be time to build one.

“You really need to have interviewers establish rapport and relationship with the client prior to conducting or doing any assessment, because if they don’t trust interviewers, they’re just not going to talk to them,” said Cronley, the University of Tennessee professor.

The stakes are high: When an interviewer chooses the “Client refused” option from the pull-down menu of potential answers, the applicant receives zero points for that question.

Valdéz also sees lack of trust as a problem in the communities she serves. “Many of us would not feel comfortable speaking about our personal traumas, in 45 minutes, to a complete stranger,” she said. “My family experienced homelessness, and I can tell you right now, if I’m sitting in front of someone that I’ve just met, it is very unlikely that I would share that in an assessment.”

This was a concern voiced by Auerswald, the Berkeley professor, about the youth questions on violence and trading sex for a place to stay. She said the phrasing would not secure accurate results.

“My worries here is that a lot of young people are gonna say no,” she said. “And obviously, here, they really need to say yes. It’s one of their only hopes at prioritizing for housing, even though it’s a super traumatizing question.”

People’s personal interpretation of each question can affect their answers, Auerswald said. “A lot of young people who are trafficked would say no to this question,” she said. “They’d say, ‘Well I wasn’t raped, it wasn’t violent. I have someone taking care of me and I am paid or given something in exchange.’ Definitions of violence are different now. Violence is a lot of things. You can have sex under threat of violence, even if you don’t have a mark on you.”

Cronley said racial bias in child welfare and policing plays a similar role in determining how forthcoming people are willing to be when answering these questions.

“Black women are going to be more likely to fear that their children will be taken away from them if they report illicit behaviors, or if they report any sort of mental health challenges,” she said. “If you’ve got kids and you’re homeless and you’ve traded sex for money, you’re not going to tell them that you did that. No way.”

Daniel Liévano for ProPublica

Critics of San Francisco’s coordinated entry assessment say it’s biased against groups like immigrants, young people and transgender people.

Davis had enough experience with systems for homeless people that she knew not answering the questions was not an option. “I had no choice but to answer them or I couldn’t get into housing,” she said.

For some, though, the experience is so uncomfortable that they drop out of the process entirely. A native of El Salvador, Luis Reyes has lived in San Francisco for 30 years and been homeless for 10 of those. Reyes said he has taken the coordinated entry questionnaire twice — once in 2019 and again in 2020, right before the pandemic hit. Like Davis, he went to the brick building at 123 10th St., the city’s largest drop-in center for these assessments.

“There was a guy who did the assessment in Spanish,” Reyes said, through an interpreter, of his 2020 interview. “‘Are you incapacitated? Are you a senior citizen? Do you have AIDS?’” Reyes remembers him asking. “He even asked me if I was gay,” he recalls — a question that is not included in the coordinated entry assessment. Reyes answered no to all of the above and says he was then told he didn’t qualify for housing.

The experience discouraged Reyes, who was living in a shelter at the time of his second assessment. He decided not to take the questionnaire again. He has spent some months sleeping in his car, and more recently he stayed with his girlfriend at a senior living facility. But she’s not allowed to have guests, and soon he will have to return to the streets.

System Under Review

Across the country, cities and counties are starting to critically examine their coordinated entry systems. Last year, eight communities, including Chicago and Austin, Texas, studied the data on their coordinated entry results and discovered significant racial disparities. Both cities revised their systems using community feedback, redesigned their processes and wound up approving more people of color for services.

In San Francisco, 17,000 coordinated entry assessments were conducted between the launch of the system in 2018 and the middle of 2021. This year, the city announced it would be undertaking its own review to determine if the government is serving people equitably and if the housing options offered are a good fit for those in need. Nagendra, at the Department of Homelessness and Supportive Housing, is overseeing the city’s review.

“If things have gotten away from our overall intention and design, we can look at those things and figure out where we need to redesign, refresh, whatever it might be,” she said in an interview.

The city’s approach to its review is driven by data and leans heavily on interviews, which are being conducted in focus groups and through outreach at encampments. The agency plans to make the research findings public in late May.

Critics would like to see a more radical overhaul of the coordinated entry system and the way it is pegged only to the supply of housing.

Joe Wilson, executive director of Hospitality House, a community center for homeless people in the Tenderloin neighborhood, where the majority of the city’s unhoused population resides, explains the problem with that approach.

“This algorithmic-based decision-making process is designed to keep the problem small enough so we don’t have to truly address it,” he said in an interview. “They’re not filling housing based on need, they’re assigning it based on capacity. It is not logical, it’s not consistent, and it’s not effective.”

For example, families used to be required to hit 40 points to qualify for housing. In February, the Department of Homelessness and Supportive Housing doubled that number to 80 points due to a shortage of family-specific housing. Owens, the coordinated entry manager at the department, estimated that the change would reduce the number of families who qualified for housing to between 50% and 60% of those taking the assessment, down from 75%.

Critics of the coordinated entry program have been proposing solutions as the city begins its review. In a February report, the Coalition on Homelessness, San Francisco’s largest nonprofit advocating for homeless people, recommended that the city “develop an assessment tool that categorizes people according to what type of housing would be the most suitable for their situation, instead of assigning them an eligibility score. This will tell us what type of housing and assistance is needed, versus how much housing we have.”

The organization also proposes letting case workers and housing providers work together to identify the best place to house an applicant. This approach, the Coalition argues, would create “a real-time housing placement system” that would more quickly bring vulnerable people indoors. This could help address the city’s chronic difficulty in filling the vacant units it has available: As the San Francisco Public Press and ProPublica reported in February, 1,633 people who had been approved for housing were still waiting to move in — some for months — even as more than 800 apartments sat vacant. At least 400 people had been on the waitlist for more than a year.

For those working on the front lines of the homelessness crisis, change to the coordinated entry system can’t come fast enough. Last July, in a meeting with the Department of Homelessness and Supportive Housing, Wilson told a story about a client his organization had helped.

“We have an 86-year-old woman who has been homeless for 14 years who has not been prioritized for housing,” he said, noting that she took a coordinated entry assessment but did not hit the 118-point threshold for housing.

A key insight from that experience, he said: Algorithmic decision-making “moves us away from the absolute necessity of human judgment and human interaction in human services.”

The post San Francisco Rations Housing by Scoring Homeless Folks’s Trauma. By Design, Most Fail to Qualify. appeared first on Los Gatos News And Events.

This article was produced for ProPublica’s Local Reporting Network in partnership with the San Francisco Public Press. Sign up for Dispatches to get stories like this one as soon as they are published.

Tabitha Davis had just lost twins in childbirth and was facing homelessness. The 23-year-old had slept on friends’ floors for the first seven months of her pregnancy, before being accepted to a temporary housing program for pregnant women. But with the loss of the twins, the housing program she’d applied to live in after giving birth — intended for families — was no longer an option.

After several weeks in a hotel, which a prenatal program for homeless people had paid for while she recovered, Davis went to a brick building in San Francisco’s South of Market neighborhood to apply for a permanent, subsidized housing unit. There, a case worker she’d never met asked her more than a dozen questions to determine if she was eligible.

Some of the things he asked: Have you ever been sexually assaulted while experiencing homelessness? Have you ever had to use violence to keep yourself safe while experiencing homelessness? Have you ever exchanged sex for a place to stay? “Those are the questions that really bothered me,” she said. “Whatever my experience is of being sexually assaulted, or what I had to do in order to stay safe on the streets, shouldn’t pertain to whether or not I deserve housing.”

That day, Davis was informed that the score she’d been given based on her answers to the questionnaire wasn’t high enough to qualify for permanent supportive housing. It was a devastating blow after an already traumatizing few months. “I thought, ‘You put me on the streets right now, mentally, I will kill myself,’” she said.

What Davis encountered with those questions is called coordinated entry, a system designed to match people experiencing homelessness with housing. In San Francisco’s system, applicants are asked 16 core questions, and their answers are given a point value which is then tallied. The total number is intended to reflect applicants’ vulnerability; currently, a score of 118 points means they qualify for one of the city’s permanent supportive housing units, which is subsidized by the government and comes with wraparound supportive services. Applicants with lower scores may qualify for rent assistance or a bus ticket out of town, but if they want housing in San Francisco, they have to wait six months before taking the test again.

Though the city’s Department of Homelessness and Supportive Housing has an annual budget of $598 million and the majority of that is spent on housing, there simply aren’t enough permanent supportive housing units available to accommodate the thousands of homeless people in San Francisco. (A 2019 survey estimated the number of homeless people at more than 8,000.) The threshold for approval is directly tied to housing availability, and right now, roughly one-third of people who take the assessment score high enough to qualify.

“It’s really prioritizing scarce resources,” said Cynthia Nagendra, the department’s deputy director of planning and strategy. “There has to be some prioritization, unfortunately, until we have some housing resource for every single person.”

Coordinated entry was meant to be a more objective tool than the previous system, which offered resources on a first-come, first-served basis. In contrast, coordinated entry aims to determine who is most vulnerable and who should therefore get access to the limited supply of available housing.

Through records requests, the San Francisco Public Press and ProPublica obtained the questions and scoring algorithm used in San Francisco’s coordinated entry questionnaire, which has never before been made public. The news organizations solicited feedback on that tool from front-line workers, academics and people experiencing homeless. Some raised objections to how the questions were phrased. Others pointed out inequities in the scoring. And many more criticized the way it was administered, suggesting that the process itself — in which applicants are asked very personal questions by a stranger — might make it unlikely that already-distressed people would answer accurately.

In our interviews, it became clear that the survey fails to identify many of the vulnerabilities it was intended to catch. And what was supposed to be an objective tool winds up, as a result of how it’s written and administered, making it harder for certain populations — immigrants, young people and transgender people, among others — to get indoors, experts and advocates told us.

For Davis, that meant some of the hardships she was experiencing were overlooked. For instance, there was no question in the survey that would give her points for the losses she had just suffered. Failing to qualify for housing resulted in weeks of stress and instability while she recovered from the trauma of losing her children. Eventually, with the assistance of case workers at several organizations, she found a place in a transitional housing program for youth. But being told, during the lowest moment of her life, that she did not qualify for permanent housing left its mark. “It made me feel invalid in my own experience,” she said.

In response to these critiques, homelessness department spokesperson Denny Machuca-Grebe said in an email, “I want to make it clear that anyone who comes to our department for help should NOT ‘be left out.’” For those deemed ineligible for housing, he said the city offers other services; these may include shelter placements, relocation help and rental assistance. In general, the department had not responded to requests for comments about individual cases in the past, and it didn’t comment on Davis’ experience.

Excluded Populations

Coordinated entry was first implemented in 2018, after the Department of Housing and Urban Development began requiring regions that apply for federal homelessness funds to create a tool “to ensure that people who need assistance the most can receive it in a timely manner.” Much of the rest of the country adopted a tool called the Vulnerability Index, Service Prioritization Decision Assistance Tool. San Francisco developed its own set of questions, intended to determine which unhoused people are in greatest need of a home.

In the four years since the requirement was implemented, some cities and counties have reviewed their coordinated entry systems and uncovered trends such as significant racial or gender biases. A 2019 analysis of data from Oregon, Virginia, and Washington found that even though people of color were overrepresented in the homeless population, they tended to score significantly lower than their white counterparts, making it harder for them to access permanent supportive housing. The study recommended that HUD consider revising its coordinated entry guidelines to ensure that communities “equitably allocate resources and services.” This year, San Francisco started its own analysis of its coordinated entry process, and it expects to present the findings before the end of the year.

Nearly every expert we interviewed suggested that the experiences of people of color may not be fully reflected in their answers to the coordinated entry questions. San Francisco’s own data shows Black, white, Asian and Indigenous people being approved for housing at roughly equal rates. But Nagendra, from the Department of Homelessness and Supportive Housing, is looking into concerns that conditions that often make people of color more vulnerable are not being fully captured and that the numbers may not tell the whole story. “When you look at quantitative data, ours will show we are actually prioritizing people who are Black at an equitable rate. But when we talk to people, they might tell a different story,” she said.

Courtney Cronley, an associate professor of social work at the University of Tennessee who has written about racial bias in coordinated entry systems, pointed to one of San Francisco’s questions as an example of possible bias in action: “How many times have you used crisis services in the past year (for example, mental health crisis services, hospital, detox, suicide prevention hotline)?”

“Black people are less likely to use formal health care systems,” Cronley said. “They’ll reach out to family and friends and social support systems rather than going to the doctor. The doctor is not someone that they necessarily trust. These questions are biased towards persons who are white in our communities and biased against African Americans.”

The Department of Homeslessness and Supportive Housing has also said that very few transgender and gender-nonconforming people have been taking coordinated entry assessments. In a December 2021 meeting, Megan Owens, the department’s coordinated entry manager, presented demographic data on who was being assessed. She said that the number of people reporting those gender identities during assessments is “lower than in the best estimates of the homeless population.” In March, city data showed that transgender and gender-nonconforming people constituted only 2% of those taking assessments to try to get housing.

Critics of San Francisco’s coordinated entry system also say that one of the most basic questions, “How long have you been homeless this time?” leads to the exclusion of immigrants and younger people.

That question might sound simple, but it’s difficult for many people to say how long they’ve been homeless — and answering accurately can be critical to getting housing. That’s because San Francisco’s algorithm grants people more points the longer they have been unhoused: A person who has been homeless for more than 15 years receives 12 more points than someone who’s been homeless for one to two years. Anyone who says they’ve been homeless for less than a year gets zero points on this question. (On average, adults who qualify for housing in San Francisco report being homeless for six years.)

Credit:
Daniel Liévano for ProPublica

Gayle Roberts, the chief development officer at Larkin Street Youth Services, a nonprofit serving young homeless people in San Francisco, said it is “common knowledge among social service providers that it [the coordinated entry system] is weighted heavily toward serving the needs of those who have experienced homelessness the longest.”

Laura Valdéz, executive director of Dolores Street Community Services, is one of several nonprofit leaders who questioned the efficacy of the system. “For many newly arrived immigrants, the way they literally interpret that question is since they’ve been here in San Francisco,” she explained. “So their scores are really low in comparison to other folks. But a large percentage of our immigrant community were unhoused in their home country.”

Valdéz also said the coordinated entry system can lead people living outdoors to accrue significant trauma before they qualify for permanent supportive housing. The program, she said, “requires people to stay in that system that is creating greater and greater harm to them for them to be able to score higher.”

The duration-of-homelessness question can also be tricky for homeless youth, defined as those between 18 and 24. In a 2019 count, they accounted for 14% of the city’s homeless population. Many young people are intermittently homeless, making it difficult to calculate the full length of that experience, said Dr. Colette Auerswald, a professor of community health sciences at the University of California, Berkeley.

“Maybe they stayed on their friend’s couch for five days and they were on a bus last night,” she said. “So they may be like, ‘Well, one day,’ but actually they’ve been in an unstable situation for a really long time.”

San Francisco’s homelessness department acknowledges this bias against young people seeking housing. In an attempt to address the age gap, the department included two questions that are only scored for people ages 18 to 24: “In the place you are staying, are you experiencing physical or sexual violence?” and, “In the last 12 months have you traded sex for a place to stay?” If they answer yes to either one, it provides a significant bump in their overall score: 12 points for each question. But if anyone older than 24 who has been sexually assaulted or has traded sex for a place to stay gets no points at all. (While the answers to these questions are only scored for 18-to-24-year-olds, they are asked of every person who takes the assessment. When asked why these questions were asked of people who could not receive points for answering, the department said it was for “data gathering.”)

Machuca-Grebe, the department spokesperson, explained that the question was added because “we have found that without the score placed on the questions for youth, they would be seriously under prioritized — leading to a disproportionate exclusion of youth.”

Davis was in the 18-to-24 age range when she first took her coordinated entry assessment, so those questions were scored. But she does not believe they should be asked at all.

“There’s not a single person that I can think of that is female-presenting that hasn’t been sexually assaulted while experiencing any part of their life, not just homelessness,” she said. “So you’re telling me that because someone hasn’t been raped, that she doesn’t get housing, and then she stays on the streets and then does get raped? And now she can? No, that doesn’t make sense.”

Questions From a Stranger

It is not just the wording and scoring of the questions that give experts pause. They also said that the way the assessment is given can fail to accurately assess a person’s vulnerability.

In San Francisco, all questions must be read by a trained staff member from one of the nonprofits that contract with the city to conduct the assessment. The questions are pulled up on an iPad or a computer. A drop-down menu offers a prewritten set of answers to select from, and the score is automatically added up by the software.

Coordinated entry assessments are frequently conducted in semi-public places, like a bustling office or a street corner under a highway. Applicants rarely have a preexisting relationship with the person asking the questions, and, due to understaffing at many nonprofits conducting assessments and the high number of people in need, there may not be time to build one.

“You really need to have interviewers establish rapport and relationship with the client prior to conducting or doing any assessment, because if they don’t trust interviewers, they’re just not going to talk to them,” said Cronley, the University of Tennessee professor.

The stakes are high: When an interviewer chooses the “Client refused” option from the pull-down menu of potential answers, the applicant receives zero points for that question.

Valdéz also sees lack of trust as a problem in the communities she serves. “Many of us would not feel comfortable speaking about our personal traumas, in 45 minutes, to a complete stranger,” she said. “My family experienced homelessness, and I can tell you right now, if I’m sitting in front of someone that I’ve just met, it is very unlikely that I would share that in an assessment.”

This was a concern voiced by Auerswald, the Berkeley professor, about the youth questions on violence and trading sex for a place to stay. She said the phrasing would not secure accurate results.

“My worries here is that a lot of young people are gonna say no,” she said. “And obviously, here, they really need to say yes. It’s one of their only hopes at prioritizing for housing, even though it’s a super traumatizing question.”

People’s personal interpretation of each question can affect their answers, Auerswald said. “A lot of young people who are trafficked would say no to this question,” she said. “They’d say, ‘Well I wasn’t raped, it wasn’t violent. I have someone taking care of me and I am paid or given something in exchange.’ Definitions of violence are different now. Violence is a lot of things. You can have sex under threat of violence, even if you don’t have a mark on you.”

Cronley said racial bias in child welfare and policing plays a similar role in determining how forthcoming people are willing to be when answering these questions.

“Black women are going to be more likely to fear that their children will be taken away from them if they report illicit behaviors, or if they report any sort of mental health challenges,” she said. “If you’ve got kids and you’re homeless and you’ve traded sex for money, you’re not going to tell them that you did that. No way.”

Credit:
Daniel Liévano for ProPublica

Davis had enough experience with systems for homeless people that she knew not answering the questions was not an option. “I had no choice but to answer them or I couldn’t get into housing,” she said.

For some, though, the experience is so uncomfortable that they drop out of the process entirely. A native of El Salvador, Luis Reyes has lived in San Francisco for 30 years and been homeless for 10 of those. Reyes said he has taken the coordinated entry questionnaire twice — once in 2019 and again in 2020, right before the pandemic hit. Like Davis, he went to the brick building at 123 10th St., the city’s largest drop-in center for these assessments.

“There was a guy who did the assessment in Spanish,” Reyes said, through an interpreter, of his 2020 interview. “‘Are you incapacitated? Are you a senior citizen? Do you have AIDS?’” Reyes remembers him asking. “He even asked me if I was gay,” he recalls — a question that is not included in the coordinated entry assessment. Reyes answered no to all of the above and says he was then told he didn’t qualify for housing.

The experience discouraged Reyes, who was living in a shelter at the time of his second assessment. He decided not to take the questionnaire again. He has spent some months sleeping in his car, and more recently he stayed with his girlfriend at a senior living facility. But she’s not allowed to have guests, and soon he will have to return to the streets.

System Under Review

Across the country, cities and counties are starting to critically examine their coordinated entry systems. Last year, eight communities, including Chicago and Austin, Texas, studied the data on their coordinated entry results and discovered significant racial disparities. Both cities revised their systems using community feedback, redesigned their processes and wound up approving more people of color for services.

In San Francisco, 17,000 coordinated entry assessments were conducted between the launch of the system in 2018 and the middle of 2021. This year, the city announced it would be undertaking its own review to determine if the government is serving people equitably and if the housing options offered are a good fit for those in need. Nagendra, at the Department of Homelessness and Supportive Housing, is overseeing the city’s review.

“If things have gotten away from our overall intention and design, we can look at those things and figure out where we need to redesign, refresh, whatever it might be,” she said in an interview.

The city’s approach to its review is driven by data and leans heavily on interviews, which are being conducted in focus groups and through outreach at encampments. The agency plans to make the research findings public in late May.

Critics would like to see a more radical overhaul of the coordinated entry system and the way it is pegged only to the supply of housing.

Joe Wilson, executive director of Hospitality House, a community center for homeless people in the Tenderloin neighborhood, where the majority of the city’s unhoused population resides, explains the problem with that approach.

“This algorithmic-based decision-making process is designed to keep the problem small enough so we don’t have to truly address it,” he said in an interview. “They’re not filling housing based on need, they’re assigning it based on capacity. It is not logical, it’s not consistent, and it’s not effective.”

For example, families used to be required to hit 40 points to qualify for housing. In February, the Department of Homelessness and Supportive Housing doubled that number to 80 points due to a shortage of family-specific housing. Owens, the coordinated entry manager at the department, estimated that the change would reduce the number of families who qualified for housing to between 50% and 60% of those taking the assessment, down from 75%.

Critics of the coordinated entry program have been proposing solutions as the city begins its review. In a February report, the Coalition on Homelessness, San Francisco’s largest nonprofit advocating for homeless people, recommended that the city “develop an assessment tool that categorizes people according to what type of housing would be the most suitable for their situation, instead of assigning them an eligibility score. This will tell us what type of housing and assistance is needed, versus how much housing we have.”

The organization also proposes letting case workers and housing providers work together to identify the best place to house an applicant. This approach, the Coalition argues, would create “a real-time housing placement system” that would more quickly bring vulnerable people indoors. This could help address the city’s chronic difficulty in filling the vacant units it has available: As the San Francisco Public Press and ProPublica reported in February, 1,633 people who had been approved for housing were still waiting to move in — some for months — even as more than 800 apartments sat vacant. At least 400 people had been on the waitlist for more than a year.

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For those working on the front lines of the homelessness crisis, change to the coordinated entry system can’t come fast enough. Last July, in a meeting with the Department of Homelessness and Supportive Housing, Wilson told a story about a client his organization had helped.

“We have an 86-year-old woman who has been homeless for 14 years who has not been prioritized for housing,” he said, noting that she took a coordinated entry assessment but did not hit the 118-point threshold for housing.

A key insight from that experience, he said: Algorithmic decision-making “moves us away from the absolute necessity of human judgment and human interaction in human services.”

The post San Francisco Rations Housing by Scoring Homeless Individuals’s Trauma. By Design, Most Fail to Qualify. — ProPublica appeared first on Los Gatos News And Events.

Known for her philanthropic and community service work, Pam Baer has been Involved in numerous causes over the years. One of the reasons for this has top priority Was in the public Health care system and more precisely, mentally and behavioral health.

As the lifelong director of the San Francisco General Hospital Foundation ((SFGHF), Pam was instrumental in This is how capital campaigns, events and strategies work Help fund solutions for the most vulnerable in our community.

T.he pandemic and its consequences has brought to light an array of relevant issues and the need to provide even more support to public health. There is a great need to support the vulnerable and Pile of sugar San Francisco General Hospital ((ZSFG) remains a safety net for so many. As a result, Pam Bear’s commitment to the cause of the foundation continues.

T.The committed team at ZSFG thThey suffer from poverty, homelessness and a lack of insurance, as well as recent immigrants and local color communities. Since the beginning of the pandemic last year, the foundation has had its focused on the subject how a person’s socio-economic circumstances can directly affect their overall health and wellbeing.

The San Francisco General Hospital Foundation‘s The 2021 mission is to “support and fund excellence in patient care and innovation at the Zuckerberg San Francisco General Hospital and Trauma Center because we believe in the equity, access, and quality of health care for all.”

“Issues out mental health is widespread among our most vulnerable citizens. This went hand in hand with the COVID crisis Has the general Operation at full capacity have to support the community through it Double pandemic. ”, Pam Bear Conditions.

In 2018 she helped too create and start the Transform Mental & Behavioral Health Fund. The organization supports and pilots Mental health Programs and initiatives and has raised more than $ 5 million since its inception. The aim is to ensure barrier-free care and to destigmatize mental health problems. However, when the pandemic broke out, the demand for mental health facilities and support was further highlighted. Now in phase two, the fund is picking up speed to meet this challenge. The Transform Mental and Behavioral Health Fund helped fund and initiate prÖGrammes like the Acute Care Team and Telecare Health in order to Make care safe and accessible through the COVID pandemic.

The post Pam Baer helps the Zuckerberg San Francisco Basic Hospital and Trauma Middle via the pandemic appeared first on Los Gatos News And Events.