San Antonio`s IMPACT Taking Homeless Outreach to Another Level

When city leaders of San Antonio, TX, began focusing on the homeless population earlier this year, Jesse Trevino and William Kasberg were ready to roll.

A year earlier, Trevino and Kasberg, plainclothes police officers working in the San Antonio Police Department (SAPD) Mental Health Unit, had been tasked with reaching out to the homeless population in the nation’s seventh-most populated city.

“These people were broken down; some had been through some terrific atrocities. One day, a homeless man was set on fire while he was sleeping. Another guy had been run over by a car and still had the wiring of his jaw holding his face together,” says Trevino.

At first, the homeless were wary of Trevino and Kasberg. The SAPD had heavily enforced the law related to homelessness through arrests and tickets. “It got to the point where they (city leaders) realized it wasn't working for our sub-population of the chronically homeless, especially those who were mentally ill or drug dependent,” says Trevino.

In their search, Trevino and Kasberg found a homeless man on a downtown park bench they called Mr. Handy. He became a SAPD case study to better understand how the system worked—and when it didn’t. A bipolar, alcohol-dependent, African-American male with major medical problems, Mr. Handy was initially reluctant to talk to the officers.

“It took us a long time to gain his trust,” says Trevino. “We pointed him in what we thought was the right direction, left him in good hands, and moved on.”

Not much later, Trevino and Kasberg found Mr. Handy on the same park bench.

“He’d fallen through the cracks and we didn’t know what to do next,” admits Trevino. Before they could locate Mr. Handy again, he died in a port-a-potty. “We felt that he’d still be alive if we’d just maybe taken an extra step and had him looked at medically.”

Mr. Handy’s death drew the attention of SAPD Chief William McManus, who had rejoined the department last October. One of his first priorities, he stressed, would be to change the way his department and the city interacts with the homeless population.

“A ticket, a pair of handcuffs, or a night in jail isn’t going to affect someone of that nature, and the chief recognized that. He also saw statistics showing many homeless are substance-dependent or mentally ill, or both. His concern is to try to find the gaps in continuity of care, bridge those gaps, and get them help.”

Trevino points out that confronting homelessness wasn’t a total solution. “There's a mental health component, there's a medical component, and they were tying up patrol vehicles, fire apparatus, EMS apparatus and jamming up ERs excessively, and we were just making runs and no one was really getting to the core of their problem.”

Earlier this year, McManus, along with San Antonio Fire Department Chief Charles Hood, announced IMPACT (Integrated Mobile Partners Action Care Team), a new program that involves a more effective and efficient collaborative approach to homelessness and general high users of community resources.

Through IMPACT, multi-agency teams offer the homeless medical treatment or navigation through the city’s social service network. The member teams include representatives of SAPD’s Mental Health Unit such as Trevino and Kasberg, San Antonio Fire Department EMS mobile integrated healthcare paramedics and caseworkers from charitable agencies.

The approach also serves to reduce the volume of unnecessary 9-1-1 calls, often generated by homeless people not truly needing immediate medical attention, notes Hood, a 17-year paramedic who worked with the homeless in Phoenix, AZ.

“Every city has a homeless issue, and if they don’t look at ways to confront it, they’re going to continue going on those high-usage calls,” says Hood.

For now, the program is too new to determine success quantitatively.

“We don't know what success would even mean or what we should be looking at. The end goal would be to find these people in crisis or high or drunk out on the street, restore them, and then get them a place to live. That is the goal and the challenge. If we were able to help at least some individuals get on their feet and get better, it would be successful. And we have,” emphasizes Trevino.

The teams are running into people on the street who thank them for the help they received.

“They are sober now or they are on their meds,” says Trevino. “Every now and then you will run into those that have to be put in the hospital again. We haven't seen them in a few months, but they are coming back down and crashing. We argue they weren't causing any problems for those months. For those months, EMS wasn't responding to a down and out, and the police weren't putting them in jail. They weren’t causing any major issues for the city or effecting perceptions of public safety.”

Trevino, who sees interest in the program in other cities, has advice for those considering their own.

“Before you make policy, make sure you have all of your mechanisms in place. Work with your mental health authority. Use your substance abuse dependence hospitals and know your social services network. Consider housing first perspectives, and really look at every aspect from everyone's lens before pulling the trigger on policy. Implementation issues will arise. Having contingencies in place will minimize those. Have a formal evaluation component where you know what metrics you have and you know what your goals are. Otherwise you may be running around in circles in the beginning.”