This article is adapted from an episode of our podcast, “Civic.” Click the audio player below to hear the full story.
For generations, young people in need could walk into centers in San Francisco’s Tenderloin and Haight-Ashbury neighborhoods and find medical care, mental health treatment, and connections to housing and other support services under one roof.
Now the city Department of Public Health plans to close the medical clinics in these specialized youth centers, and shift patients and staff to larger primary care sites as it responds to deep cuts to federal and state Medi-Cal funding.
Supporters say the plan would erode decades of investment in youth-centered care, ending a model that grew out of San Francisco’s long history of meeting young people where they are, not asking them to navigate a fragmented healthcare system on their own.
For more than 30 years, the Michael Baxter Larkin Street Youth Medical Clinic has operated within Larkin Street Youth Services in the Tenderloin, while the Cole Street Youth Clinic has operated within the Huckleberry Youth Health Center in the Haight.
Together, the clinics embodied a broader philosophy: Vulnerable people ages 12 to 25 were more likely to seek care when medical services were embedded within organizations they already trusted. Rather than sending them from one agency to another, the clinics combined primary care, behavioral health, reproductive health, and connections to housing and other support services under one roof.
Former Larkin patient Alyana Perez said that support changed the course of her life after she survived abuse and homelessness.
“If you take these clinics away, it will kill a lot of people,” Perez told city officials during public testimony in April.
This episode of “Civic” traces the history of San Francisco’s youth health clinics from the Summer of Love to today, examining how a pioneering model of integrated care for vulnerable young people has come under threat amid the city’s budget crisis.
The philosophy of integrated care for youth dates from 1967, when Huckleberry House became the nation’s first shelter for runaway youth. Staff members quickly realized that homeless and disconnected teenagers needed more than a bed. They needed medical care, mental health treatment, sexual health services and opportunities to connect with trusted adults, all in one place.
Healthcare providers initially met those needs by making house calls. During the HIV epidemic in the 1980s, Huckleberry expanded its focus on prevention and youth health education, which evolved into what is now the Huckleberry Youth Health Center and the Cole Street Youth Clinic.
Jackie Miller, program coordinator at Huckleberry Youth Programs, said the clinic remains central to the organization’s mission.
“It’s essentially one of our core programs,” Miller said.
In the 1990s, Larkin Street Youth Services developed a parallel model, offering primary care, behavioral health, sexual and reproductive health services and urgent care within its programming for youth experiencing homelessness and other vulnerable young people.
For decades, the Department of Public Health invested in that approach, partnering with community nonprofits to embed youth clinics inside organizations already serving vulnerable adolescents. The model proved influential, helping inspire youth-focused health and social service programs in communities across the country.
Now officials say the city can no longer afford it.
Dr. Blake Gregory, director of San Francisco Health Network Primary Care, acknowledged the difficulty of the decision at an April Health Commission meeting.
“These have been gut-wrenching decisions,” Gregory said. “Some of the hardest things that I’ve had to do in my career.”
Gregory said the youth clinics serve relatively few patients — a combined 612 unique visits annually — so young clients will be transitioned to adult primary care clinics, while clinicians and other staff will be reassigned to higher-demand locations. The department also proposed a pilot program in which a nurse would remain at the youth centers to offer virtual appointments with nurse practitioners and behavioral health clinicians instead of in-person visits.
Clinic staff said unique patient counts and daily visits don’t capture the intensity of youth-centered care, which often involves longer visits, behavioral health support, crisis intervention, coordination with case managers and repeated interactions that aren’t comparable to a typical adult primary care clinic.
Lisa Cadillo, a medical evaluation assistant at the Michael Baxter Larkin Street Youth Services Medical Clinic, said much of her work begins long before a patient sees a clinician. When frightened or angry teenagers arrive, she often takes them aside simply to listen to them.
“We don’t know what these young folks are going through on a day-to-day basis,” she said. “This is where I’m supposed to be, to guide the young ones that don’t have that support system.”
Miller said moving patients into adult clinics ignores why specialized youth clinics were created and warned that many young people would simply stop seeking care if trusted providers disappeared.
“Places for adults are not good places for young people,” Miller said. “They have different needs.”
Meanwhile, Service Employees International Union Local 1021 spokesperson Jennie Smith-Camejo said the union secured a telehealth pilot program and avoided job loss through impact bargaining. The union is holding a formal meet-and-confer process to negotiate staffing and clinic operations, with the stated goal of keeping the clinics open and properly resourced.
