January 29, 2021 – By Chad Smith

To promote health and safety during the COVID-19 pandemic, the City and County of San Francisco rapidly moved over 2,000 people experiencing homelessness into city-contracted private hotels. These hotels, however, did not all have working phones available for guest use, thereby limiting essential services and connections for guests. The California COVID Command Center, a mixture of departments across cities, was tasked in June 2020 to initiate a pilot program to support phone access in these accommodations. As guests were being asked to shelter-in-place, telephonic communication was critical for vulnerable populations to access case management, behavioral and mental health supports, wellness screenings, and connectedness to family and friends.

In collaboration with the San Francisco COVID Command Center, the San Francisco Human Services Agency, Innovation Office (SFHSAIO) completed a user-centered, data-informed, two-phase prototyping pilot to design the best approach to successfully enroll the newly-sheltered clients onto phone services in response to COVID-19.

Since 1985, the LifeLine program has provided discounted phone service for qualifying low-income consumers to ensure that all Americans have the opportunities and security that phone service brings, including being able to connect to jobs, family, and emergency services.

Who Was Involved

• San Francisco Human Services Agency, Innovation Office (SFHSAIO), in collaboration with the California COVID Command Center, providing Service Design expertise
• California Department of Public Health, providing mental health and client expertise
• California IT team, which had previously procured tablets for its housing-related work

Pilots

Two pilots launched to address the problem of getting phone access to hotel guests.

The first pilot included setting up a Google Voice number on previously-distributed tablets. Google Voice is a free service that makes it possible to send and receive calls and text messages over a cellular or WiFi data connection. The SFHSAIO team worked with a number of guests to set up Google Voice accounts that included an assigned phone number. Guests could use this new phone number on tablet devices available in their hotel. The process to set up tablets was lengthy, and some guests also did not have an email address, which had to be created in order to enroll them.

Once set up, guests could use their tablets to make and receive phone calls.

The second pilot enrolled hotel guests in telephone services through a roving, on-the-ground team. The California Lifeline Program collaborates with a large number of cell phone providers who provide cell phones at a variety of rates from free to low cost. The application process takes up to 30 days from start to finish, with field agents helping to handout phones on the ground.

After researching the LifeLine plans available that would best suit the client population, the SFHSAIO team identified two phone providers that offered free plans and free phones. The SFHSAIO team was unable to identify a field agent that could be brought on site to assist guests in registering for LifeLine phones.

The SFHSAIO team then set up a space in the hotel lobby to gather insights by enrolling clients who did not have cell phone access. The team connected clients to LifeLine program administrative assistants to resolve barriers and assist client enrollment in the program.

Pilot Recommendations

When evaluating the return on investment, the first pilot was free of charge to access, but required access to tablets or devices and human support to set up and maintain. For the second pilot, there was a cost of $57.50 per client with only a 20% successful enrollment rate, which made it infeasible for the desired goal.

Because success rates were low and staff capacity was limited during the COVID-19 emergency, after conducting both pilots, the final recommendation was to a third option: handing out pre-activated phones, with limited functionality previously activated on their carrier network, at hotel sites. This avenue would reduce the strain on scarce staff resources, while ensuring a high success rate and quicker access.

KPI Metrics

The final recommendation of handing out phones with data already activated onsite was determined after evaluating the following key performance indicators (KPIs):

1. length of time per phone registration per client
2. success rate for enrollment onto the program
3. success rate for conversion from enrollment to actually owning an activated phone
4. cost per client
5. uptake of method (i.e., frequency of usage of device)

Key Customer Journey Pain Point Learnings from Both Pilots

1. needing email address to sign-up for LifeLine program 
2. coordinating with guests during limited pilot hours
3. troubleshooting for guests with existing LifeLine accounts that could not remember their info and were locked out
4. tablet logistics (tracking, distribution, incentives for returning, thefts and damage)
5. missing identification of required documents to enroll in LifeLine

Factors to Repeat the San Francisco Pilot Learning Processes

For state and local Health and Human Services departments exploring the best approach to enroll recently-displaced vulnerable populations onto a connected phone service, building prototypes to learn from and deliver the best experience should include the following steps:

Leadership and Management Teams

• Gather voices across impacted teams: Talk to a variety of stakeholders in managerial and non-supervisory roles, in different departments, and to clients themselves to understand what’s working and identify frustrations and barriers. 
• Establish metrics or KPIs: Define success using clear realities, resources needed, cost of setup feasibility, and time to implement.
• Create strategic buy-in: Start with on-the-ground staff, and then move to Community Partner Organizations (CPO), hotel site leads, hotel site managers and clients/guests.

Direct Service, Service Design and Policy Teams

• Map barriers to enrollment: Identify barriers for different enrollment paths and plan for them upfront. Potential enrollees, for example, may not have an email address required for enrollment registration.
• Troubleshoot with guests: Sometimes guests will not have official documents available such as a government-issued ID. Working through these types of barriers will reduce guest frustration and lack of trust. 
• Manage challenges with third-party phone vendors: Carefully research third-party phone vendors to ensure clients are not a victim of fraud. Contact information for third-party vendors is not commonly available, as most community interaction is done on the ground and face-to-face. This means it’s important to go through a process of vetting reputable phone providers, and following up to ensure guests received the phones they registered for if done through third-party vendor distributors.
• Keep everyone’s “eyes on the prize”: Remember, and share in, the excitement and gratitude of having a phone again.