PUBLIC SERVICES

In addition to housing needs, the need for improved public services was the highest priority identified through the public involvement process. Crime prevention programs, employment training, and youth and senior services, child care were all emphasized repeatedly in public meetings, focus groups and surveys. Like other major and aging cities, St. Louis's population has a great need for public service delivery. The ability of the community to provide the needed quality and level of public services in an accessible means to the consumer is essential to the neighborhood viability.

While the City of St. Louis has a major role in providing public services, it also functions as a facilitator in partnership with numerous local organizations to deliver services. These organizations on the "front line" have assisted in determining priority needs and programs which for the planning period. Their input has been invaluable in defining the extent of the problem and in developing solutions.

SENIOR SERVICES

Services for older persons are found in nearly every community in Missouri. These services meet a variety of needs, especially those which become more difficult as one grows older. The services provide help towards the goal of independence for the elderly. St. Louis City's elderly (those 62 or older) make up 16.6% of the City's total population. They are generally a less affluent group; the income levels of the City's elderly households fall below both the average and median household income levels for the City. Overall, about 21% of all elderly households live in poverty. These percentages make clear the need to improve, maintain and expand the range of available services.

The primary services currently available are broken into four categories: Community Services, In-Home Services, Alternate Living, and Financial Assistance.

Community Services are those available on a community level to help older persons live independently. Examples include the following:

• Transportation: Available City-wide Transportation (A.C.T.) provides service to elderly persons who are in need of transportation to medical appointments, necessary business.
• Senior Centers: They typically offer meals and social activity.
• Adult Day Care: These centers offer services ranging from health care to social programs. At an adult day care center, older persons may receive a hot meal, snacks, counseling, therapy, and assistance with medications and personal care.
• Legal Assistance: The Legal Services Program provides legal assistance to elderly citizens of limited means through the Elderly Law Unit of the Legal Services of Eastern Missouri, Inc. Also, St. Louis University law students under the supervision of a law professor assist the elderly at several senior centers. They provide such assistance as trusts and living wills, power of attorney, guardianship, conservatorship, and advanced health care directives.
• Support Groups: These offer a regular place for people to meet and get information about community resources, gain understanding about certain behaviors, receive emotional support, learn specific coping strategies, and are encouraged to rebuild their personal lives.
• Information and Referral: Elderly citizens have questions about the availability of services, eligibility requirements, and how to contact the appropriate agency. All Area Agencies on Aging in Missouri provide information services, as do most senior centers.
• Health Care Services: When health care is needed, both diagnostic and medical services can be sought through a private physician. When necessary, the family physician can make referrals to a specialist, a hospital or other health services. Other available health services include Health Maintenance Organizations (HMO's), Health Promotion Services, Mental Health care and diagnostic services, Ambulance Services, Discharge Planning, and Hospice programs for terminally ill persons and their families in the final stages of disease.
• Case Management/Care Coordination: A trained person evaluates the condition of an older person and recommends services to meet particular needs. Case management is generally available through the Division of Aging and some local Area Agencies on Aging.

• Personal care such as assistance bathing
• Companionship including telephone reassurance, friendly visiting, senior companion program, and church programs
• Home Health Services including durable medical equipment and speech/physical therapy
• In-Home Respite Care
• Emergency Response Systems
• Homemaker/Chore Services
• Home Delivered Meals

• Private Developments such as congregate housing, high-rise apartments, continuing care community, and shared housing.
• Assisted housing such as HUD-Section 8 Rental Assistance, and public housing
• Nursing Facilities including Intermediate Care Facility (ICF) and Skilled Nursing Facility (SNF).
• Residential Care Facilities: Residential Care Facility (RCF-I) including room, board and protective oversight, and Residential Care Facility (RCF-II) including room, board, protective oversight, and help with daily living.
• Resident's Rights and Ombudsman Services.

Financial Assistance is the fourth category: Resources include the Food Stamp Program, Supplemental Security Income, General Relief, Medicaid, Senior Discount Card Program, Employment, Energy Assistance, Weatherization Program, and Senior Citizens Property Tax & Rent Credit.

Based on information received from the St. Louis Area Agency on Aging Information and Referral Office, as well as An Assessment of the Needs of Elderly Residents of the City of St. Louis, performed by the University of Missouri-St. Louis, the following are essential needs of the elderly in St. Louis:

• Nutrition services, including home-delivered meals, dining centers, senior centers, surplus food, and food stamps.
• Health and personal care, including visiting, public-health nursing, Medicaid, help caring for an ill family member, nursing home care and adult day care.
• Household maintenance, including homemaker (housekeeping) services, home repair services, energy assistance, and help in locating housing. Minor home repair is currently the most requested information and referral service.
• Transportation, including assistance in getting to and from health clinics, senior centers, shopping facilities, and other basic functions.

Table 41 illustrates that the number of elderly served is large. However, experts in the field estimate that the number of people who need help is a much larger number. Funding for even the current level of services has proved extremely difficult to maintain.

The need to improve, expand, and maintain those services available to the elderly is critical. The problems of the elderly are not only financial ones, although 21% of all elderly households in the City of St. Louis live in poverty, but include susceptibility to crime, poor health, difficult transportation, loneliness and boredom.

a) Increase the funds dedicated to maintaining elderly housing.

The result of fixed incomes and the cost of housing is that about 11,400 elderly renter households (52.3%) experience a housing cost burden of greater than 30%, and 5,100 households (23.4) experience a burden in excess of 50%.

b) Explore ways to support the Elderly Nutrition Program.

The replacement of recently cut funds would enable the St. Louis Area Agency On Aging to provide meals to over 100 elderly city residents on a waiting list currently not receiving nutritional services.

c) Promote additional state and federal support for elderly City residents.

Since July, 1992, SLAAA has lost $600,000 cumulative in funding. These losses have resulted in a decreased number of clients served. Specifically, units of services in three major categories have been reduced: meals, one-way trips (transportation) and in-home care. With the restoration of these funds, an increased number of elderly city residents (approximately 2,000) could receive help in all major categories.

d) Increase public awareness of the problems through advocacy.

Speaking and acting on behalf of older adults in the City of St. Louis is essential for their protection and well being. Too often the elderly are taken advantage of, and looking out for them must become a priority.

Funding sources include Federal Health & Human Services Older Americans Act funds distributed by Missouri Division of Aging, Missouri General Revenue, Home Delivered Meals Trust Fund (initiated 1993 tax year), Social Service Block Grant, U.S.D.A. Cash, Missouri Highway and Transportation Department, Community Development Agency, and City of St. Louis General Revenue.

The Community Development Agency currently provides approximately $726,000 annually from the Community Development Block Grant for meals, adult daycare, and senior home security. The City of St. Louis estimates that over the next five years total expenditures for "aging services" will be approximately $4.2 million.

An estimate by the St. Louis Area Agency on Aging suggests actual needs of the elderly which far outweighs what is currently being spent. They estimate the needs as follows:

• Meals - $89,161,251/year
• Transportation - $8,546,400/year
• Chore - $6,144,000/year
• Personal Care - $5,760,000/year
• Legal - $540,000/year
• Respite - $600,000/year
• Home Repairs - $1,000,000/year
• Utility Assistance - $1,000,000/year

These figures represent ideal funding for the period of one year. Multiplying these figures by five years results in a total need of about 563 million dollars.

YOUTH SERVICES

The problems faced by the youth of today are overwhelming. The lack of viable work skills and the absence of jobs once those skills are developed causes some youth to turn to illegal alternatives such as drugs and gangs. Other problems faced by youths, and as a result the rest of society, include runaway/pregnant teenagers (for teenage mothers under the age of 16, the danger of death during or immediately following delivery is five times higher than for women aged 20-25) and a high school dropout rate in the City of 19% in 1991-1992 (compared to 6% for the State of Missouri). One of the most difficult problems in dealing with these issues is the reluctance of those who need help to seek it. There are also difficulties with special licensing requirements for minors and the NIMBY (Not in my back yard) attitude associated with this group. Providing programs for youth was identified as a high priority throughout the public involvement process.

In order to adequately meet the needs of the City's youth, more emphasis and resources must be focused on their needs. Simply integrating them with adults in programs designed for the needs of adults is not the answer. Examples of some of the programs and agencies in St. Louis that serve youths include:

St. Louis Agency on Training and Employment (SLATE) has an especially important role as it strives to provide employment skills and work opportunities for those in need. Among their offerings are Project BJW (one half day of academic work and one half day of vocational training or academic work as part of a basic jobs-work experience); electronics training (a "pre-electronics" course designed to convey information and build confidence and pride); job referral services; and summer employment (Federally-assisted work for teenagers primarily at nonprofit agencies). SLATE works closely with many other institutions including the Board of Education (Career Education Center); Community Education Centers (core vocational skills); UMSL (community education initiatives) and the Community College District (worker reentry and related programs).

Project Respond is a "Research, Advocacy and Direct Service" organization concerned with the needs of children who are at risk in the metropolitan area. With support from the Montfort Missionaries, a small grant from UMSL, a broadly based board of directors and numerous volunteers, the organization has produced two reports - Addressing the Needs of St. Louis Children at Risk (April 1991) and The Children of Metropolitan St. Louis (April 1993). Project Respond has led to the creation of the Vision for Children at Risk (VCR) collaborative. It also offers a direct service program entitled PREPP (Project Respond Educational Pilot Program). This effort focuses on basic needs as well as academic and educational enrichment opportunities for about 25 individuals. The United Way conducts a needs assessment to assist in the development of priorities for the allocation process. Around an additional half million dollars, and a substantial amount of staff time, is conveyed to agencies concerned with these needs. The prevention of child abuse, reducing teenage drug use, school dropouts, preventing teen pregnancies, illiteracy and homelessness are examples of current or past United Way priority concerns. A number of community initiatives such as the Foster Care Coalition and Success By Six have grown with United Way backing.

Vision for Children at Risk is a coalition of more than 100 businesses, agencies and community groups representing a major initiative to address the fundamental problems of impoverished children in St. Louis. An outgrowth of Project Respond, VCR is a collaborative process built around three policy task groups, seven local community sites and a leadership panel.

Community Schools - Through June 30, 1994, Community Schools have provided 591 programs to 11,623 registrants. By broad category the frequency of offering from most to least is as follows: recreational fitness, home and family, general basic education, arts/crafts/hobbies, vocational, and college courses. An example of programming is a job readiness program at four sites for teens offered with the help of the district's Office of Career Education and the Mathews-Dickey Boys' Club.

A Youth Corps (created by The Sigel Community School in June 1994) to improve community problem solving in the service area. The Corps did a porch light survey relating to safety and created video public service announcements relating to crime prevention.

Summer offerings were a joint effort between Community Schools and the City Parks and Recreation Department. Enrollments were 1,568 for 90 programs, bringing the yearly total to date as 14, 741 for 681 offerings.

After a two year long examination, St. Louis Public Schools basically upgraded Community Schools to Community Education Centers to fulfill neighborhood needs. They established 15 Community Education Centers at sites of the former Community Schools. The Centers are concerned not only with learning of students, but also with providing school, City, State, and community services such as: education (vocational training, job readiness training, and adult literacy classes), recreation (sports, arts and crafts), social services (individual and group counseling, emergency services for families), health services (immunization, drug prevention, health screening and referrals), and cultural activities (enrichment programs such as "Time Trackers" with the Missouri Historical Society).

A major new effort as of Fall 1994 is to provide increased capacity in community decision making through resources provided by the American Youth Foundation. Through a special federal grant 23 police officers are providing community policing at the Community Education Center sites as of September 1994. City agencies, such as ConServ, are exploring with the Centers the establishment of local offices to provide city services at neighborhood locations.

Community service projects under the aegis of the American Youth Foundation will provide additional capacity building in the areas around each Community Education Center. One project deals with school success--identifying and implementing community service projects with fourth through eighth graders. The other deals with public safety issues and will have AMERICORPS members working with police personnel assigned to the COPS program. Youth Sports Grant - In FY 93 the St. Louis Housing Authority (SLHA) was awarded $123,802 to provide positive activities for youth in the public housing developments. By written agreement with the YMCA of St. Louis, social, recreational, emotional and health services are provided to residents of public housing.

The Community Education Centers (formerly Community Schools) initiative of St. Louis Public Schools seeks to provide a suitable living environment for residents of St. Louis. Centers provide taxpayers maximum benefit for the dollar by extending school building use to as many as 24 hours a day. In addition, the Centers make a variety of programs and services easily accessible to adults and children in their own communities.

Between 1994 and 1997 the Community Education Centers are already committed to improving the level of safety near each Center. The Metropolitan St. Louis Police Department has a three year grant to provide community oriented policing (COPS) around the Community Education Centers. In addition the American Youth Foundation has received AMERICORPS funding to provide community service activities as an addition to the COPS effort at the Community Education Centers. Violence prevention efforts starting as early as preschool will be provided to help youth gain the skills necessary to live in today's violent era. To the extent that further assistance is required in neighborhoods past 1997, funds may be required from HUD consolidated programs.

The costs associated with maintaining and expanding services for the youth of St. Louis City are great. According to the report of City Department Expenditures II, the expected expenditure for FY 95 - FY 99 for youth services/nutrition is $2,007,609.

A main concern in helping youths in terms of health care is that the system needs to be made more accessible and affordable for teen mothers in order to get proper prenatal care, healthy births, and good postpartum care as well as care for the baby after birth. It has been estimated that only 20 percent of pregnant teens under 15 receive prenatal care during the first trimester. Teen mothers not receiving prenatal care during this time are 93 percent more likely to suffer from anemia and 23 percent more likely to have complications associated with premature births, than are women aged 20-24. Current health services available to pregnant teens consist of public health departments and hospitals, community-based clinics and residential programs. Aid to Families with Dependent Children (AFDC) benefits are low and Women, Infants and Children (WIC) is under-funded so that many eligible women do not receive benefits.

Another difficulty for many of the City's youth is insufficient opportunities for employment. Employment offers a sense of responsibility and accomplishment for teens. It also offers them a certain amount of self-sufficiency and independence. Many working youths learn the value of time management as they balance work and school, and gain valuable job skills which may help them in future employment.

Youth employment also benefits society as a whole. Adolescent employment maximizes the productivity of our economy, and the money earned by youths is eventually pumped back into the economy. In spite of the clear benefits of youth employment, unemployment among youth is high. A combination of insufficient job attainment skills and increasing demands for higher skilled entry level workers is leaving the City's youth unemployed.

The average annual unemployment rates in 1988 and 1990 for the metropolitan St. Louis area were 6.0 and 5.9 percent respectively. The average annual unemployment rates for persons age 16-19 for those same two years were 17.5 and 17.2 percent respectively.

Numerous studies have shown a definite link between youth unemployment and a wide range of socially dysfunctional behaviors including crime, substance abuse and suicide. Self-blame, feelings of failure and incompetence were also frequently noted among youth who wanted to work, but couldn't find jobs. Youths who have dropped out of school without even minimal job skills are increasingly appearing in homeless shelters and jails. Without intervention, these youth face a lifetime of economic dependency.

One of the main objectives in providing services for youths is to keep them "off the street" and give them activities which are not only constructive but those which can give future direction. Full advantage of Community Education Centers should be taken for neighborhood purposes. If the Empowerment Zone proposal is not funded, the Community Education Center model in that document that proposes service to 10,000 residents per site should be reviewed for potential funding under HUD consolidated programs.

a) Extend the funding of those programs such as COPS (community oriented policing) and AMERICORPS which provide community service activities at Community Education Centers.

Funding is currently secured through 1997 via the Metropolitan St. Louis Police Department's COPS program and the American Youth Foundation's AMERICORPS funding. The need for these types of programs will only increase and securing funding for such programs is the first stop in making them succeed. These programs provide violence prevention efforts starting as early as preschool and are intended to help the youth of today gain the skills necessary to live in today's violent era.

b) Explore alternative sources of funds for Community Education Centers.

During the recent review of Community Education Centers, a number of organizations and individuals advocated expansion of the program into additional city neighborhoods. The St. Louis Board of Education has requested information with regards to program expansion. In order to revitalize additional St. Louis neighborhoods the following additional Community Education Centers have been proposed:

Consideration of criteria for new Centers is currently focused on community desire and readiness, geographical location, the presence of a local community council, the current lack of neighborhood based services, and condition and availability of space in a school facility. Every 2 years of expansion will require additional Community Education Office staff (with HUD Consolidated Program funding) to properly develop the Centers.

c) Expand effort to provide work opportunities for youths seeking employment.

Although there are several programs which have been developed to provide work opportunities for the City's youth, their efforts must be expanded to provide employment for the many area youth who are seeking employment, but cannot find it.

The primary effect of a lack of employment on local communities is increased poverty, which entails hunger, homelessness, and inadequate medical care. Another less visible repercussion is greater stress within families which can lead to substance abuse, domestic violence, and mental and physical health problems.

The community as a whole is impacted by higher crime and juvenile delinquency rates. Schools have a greater number of students at risk for teen pregnancy, dropout and substance abuse. Government and social service agencies are often at their limits in providing supportive services to those experiencing difficulties due to a lack of work.

Funds come from the American Youth Foundation, local businesses, agencies, and community groups, Youth Sports Grant in the amount of $123,802, The Metropolitan St. Louis Police Department, AMERICORPS funding, potential funding from HUD consolidated programs, AFDC benefits, and WIC.

The United Way provides approximately a half million dollars, and considerable staff time to agencies concerned with assessing public service needs such as teen substance abuse and pregnancy.

The City's expected allocation towards youth services/nutrition for fiscal year 1995 - fiscal year 1999 is $2,007,609.

Community Development Agency currently spends approximately $1.9 million on youth services in the City of St. Louis through the Community Development Block Grant. This is distributed as follows:

• Child Care Services - $177,500
• Community Schools - $1,050,500
• Expanded Recreation Program - $711,000

TRANSPORTATION SERVICES

An effective transportation system is an integral aspect of the City's business prosperity and quality of life. Transportation planners at Bi-State Development Agency and the East-West Gateway Coordinating Council are working to create a transportation system that will continue to be safe and that will make employment and services more easily accessible. A proposed Multi-Modal center connecting the region's inter-city bus line; light rail; AMTRAK station; airport; and a proposed heliport will be an important transportation improvement.

Transportation enhancements need to avoid improvements that will require extensive repair in the future. By using technologically advanced methods of planning and development, the agencies hope to insure that future investments will not be high maintenance. By building efficiently, future costs may be controlled, allowing for more expansion.

An important aspect of transportation planning revolves around the City's paratransit and elderly transportation system. Although the current service providers are in compliance with the Americans with Disabilities Act of 1990 (ADA), they are not capable of meeting the demand of the disabled/elderly community due to limited hours and service areas. Disabled/ elderly transportation services have shorter hours than the fixed-route mass transit system and, for the most part, do not extend beyond the St. Louis City limits. Expansion and planning will be the key to increasing availability.

Bi-State Development Authority. Serving Missouri and Illinois, this organization consists of a regional bus system which is integrated with a new 18-mile light rail line (Metrolink) making it the area's largest public transportation provider. The bus system operates a fleet of 624 buses, and operates 120 routes. Making services accessible to agency clients is an important concern.

Metrolink assists the bus line by offering convenience and accessibility. The line provides service from St. Louis' Lambert International Airport, through Downtown, ending in East St. Louis, Illinois. The line averages 27,000 passengers a day- 75 percent of light rail riders are new transportation system clients. Extension of the light rail line is currently under consideration.

Bi-State Call-A-Ride/Call-A-Ride Plus. Call-A-Ride serves the general public. Call-A-Ride Plus, under the Americans with Disabilities Act (ADA), provides transportation in eastern St. Louis County and St. Louis City. The service provides door-to-door transportation for its clients on an appointment basis. Approximately 6,200 people are served yearly, comprising 300,000 trips. Call-A-Ride has approximately 65 services vehicles, including those that are wheelchair lift equipped.

East-West Gateway Coordinating Council. This agency is a metropolitan area council of governments; a regional planning commission; and the federally appointed Metropolitan Planning Organization for the area. As a Metropolitan Planning Organization, the agency plans, and coordinates, transportation system improvements within the area.

Available City-Wide Transportation (ACT). ACT services the City's elderly and disabled communities. On an appointed basis, the service provides door-to-door transportation to more than 4,500 clients a year, involving more than 150,000 trips. ACT has 18 service vehicles and an available lift service.

Care Cab Transportation Services. Care Cab serves disabled and elderly clients, with a special emphasis on providing transportation to clients with developmental disabilities. Service is provided to ADA applicable agencies through government contract. Care Cab provides service to St. Louis City and County, as well as neighboring St. Charles County.

Missouri Highway and Transportation Department (MHTD). This State department is responsible for highway construction and maintenance. The agency is overseen by the Missouri Highway Commission.

OATS, Incorporated. Funded largely by the Older American Act, OATS' clientele is mostly comprised of the elderly in St. Louis, St. Charles, Franklin and Jefferson Counties. In the St. Louis area the agency serves approximately 2,700 persons with 72,500 trips per year.

Lack of convenient transportation is a considerable problem for the area. In some communities the transit system either does not reach essential area services, or offers a transfer system that makes trips lengthy and inconvenient. For the same reasons, the system poses a significant barrier to City workers who live in suburban areas.

Disabled and elderly transit clients are inevitably inconvenienced. Most agencies that provide transportation services for the disabled, and the elderly do so on an appointment or contractual basis. This forces clients to plan trips as much as three days in advance. These agencies also do not have the same range of service hours as the fixed-route transit system. The disabled and elderly not only have to schedule trips in advance, they have to schedule them within a limited time span. A more expeditious scheduling system, with longer service hours is needed for elderly and disabled transit customers.

Other transportation issues are currently being resolved, but still constitute areas of concern. Maintenance and replacement of transit system buses have been hindered due to a lack of funding. A lack of funding has also impeded the extension of service frequency and proposed system expansion. It is the expectation of transportation planners that the estimated additional $40 million revenue, provided by the August 1994 1/4 percent sales tax increase dedicated to the transit system, will dramatically reduce maintenance and service problems.

Planners in the St. Louis metropolitan region would like to see an expansion of the existing highways and transit system. Although the City has begun planning for an improved transportation system, costs and related problems will not allow for a large amount of development in the region. For this reason recommendations for transportation services focus on alleviating current problems and designing transportation expansion projects in the most efficient way possible.

a) Explore non-traditional methods of obtaining revenue, as a supplement to existing revenue sources, for highway and transit system projects.

The costs of highway and transit system preservation is a constant consideration in regional transportation. Although highway and transit system preservation costs do not exceed the amount of revenue allotted them, they also do not leave enough of a balance to conduct restorations or new developments. This lack of funding for preservation is due to the revenue depletion caused by extreme population shifts that have occurred in the area.

Exploring non-traditional methods of obtaining revenue, such as a more flexible system of revenue allotment for transportation will greatly add to the transportation budget. Some communities in the region have more dollars allotted to them than they need for transportation due to their high populations. Revenue reallocation will distribute the funds more evenly across all areas of the region.

b) Develop more precise planning guidelines for development and preservation.

More precise development and preservation guidelines will make future expansion more efficient in economic and developmental terms. Precise planning will reduce the likelihood of unexpected costs. EWGCC and Bi-State Development agency are currently utilizing this approach. EWGCC's Transportation Redefined:A Plan for the Region's Future, written in conjunction with Bi-State Development Agency, sets forth future transportation plans extending to 2015.

c) Expand transportation services which are available to the disabled and the elderly.

Although several agencies provide transportation services to the disabled and the elderly, service availability are typically expensive, time restricted and limited. Services should be available for the same time spans that they are available to the public at large. These services should also extend beyond a concentrated City area, thereby making more services accessible.

d) Design and build the proposed Multi-Modal Center.

A multi-modal transportation center will link the area's rail system; the inter-region bus system; the airports; a new AMTRAK station; and a proposed heliport. The clients of the Multi-Modal system will be able to change transportation modes more efficiently. The Center will also improve the transit system's accessibility to employment and services. A Multi-Modal Center will not only create a more efficient and interactive transportation system, but it will open the City to new economic opportunities.

Currently, the St. Louis transit system is drastically underfunded, hindering the possibility of major expansion. The projected transit budget for fiscal 1995 yielded a deficit of $12 million. Transit preservation costs for fiscal 1996-2000 are projected to be approximately one billion dollars, while projected revenues for fiscal 1996-2000 are only $903.9 million. At least $106 million will be needed over the next five years to fill the projected funding deficit.

Non-traditional allocation of revenue funds may be a viable option for future transportation initiative. The agencies that are most involved with these types of transportation issues, Bi-State and EWGCC, are agencies that currently implement federal transportation grants and programs. The National Highway Systems Program (NHS) and the Surface Transportation Program (STP) are examples of financial programs which are currently being utilized. Programs that are developed through non-traditional means will be supplementary to existing programs.

Funding for an expansion of disabled and elderly transportation services could come from several sources. Alternative sources should be explored for funding ADA compliant services. For agencies which are state and City funded, such as Care Cab, the plausibility of CDBG funding should be explored.

The proposed Multi-Modal Center may be supported in several ways: with tax revenues which are designated for transportation development, and by utilizing the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA). ISTEA is a federal policy which has changed transportation planning by giving states and cities increased flexibility in planning and funding. The area is currently implementing several ISTEA demonstration projects. Continued compliance with the Intermodal Surface Transportation Efficiency Act of 1991 is essential to achieving the City's transportation goals.

SUBSTANCE ABUSE SERVICES

An estimate by the St. Louis Division of Alcohol and Drug Abuse states that approximately 28,000 residents have a drug or alcohol abuse problem which significantly limits their ability to live independently. Although this number suggests the need for a large scale treatment program, in 1993 only 4,749 cases were reported to the Division of Alcohol and Drug Abuse (FY 93 excluding June). This relatively modest number of cases indicates that a major problem with substance abuse services is the availability and/or knowledge of availability of services. The lack of a central referral system in the St. Louis area and a lack of resources that would help existing programs reach out to those in need is at the center of this problem.. Since there is no system currently in existence, those in need of help generally refer to the Yellow Pages, the State Division of Drug and Alcohol Abuse, or the National Council of Alcohol and Drug Abuse. The need to reach out to the individuals who have drug and/or alcohol problems is critical.

There are numerous programs offered through various organizations attempting to service these individuals. A sampling of these programs and organizations follows.

Within the City there are two transitional facilities housing individuals for 2-6 months. There is one center which offers an in-patient program which may run longer than one month with an additional 60 days depending on need for continued treatment. Including this center, there are only three contracted centers in the City providing an in-patient one month stay. Malcolm Bliss is also relied upon for involuntary admittance.

There are five Oxford Houses in St. Louis City (coordinated by the state) which provide aftercare treatment for individuals. These homes usually accommodate 8-10 people and are self-supported by the individuals living there. The main goal for these programs is to provide a supportive atmosphere to help individuals remain drug free.

As with other special needs groups, there has also been a shift from providing in-patient services to out-patient services. Comprehensive Substance Treatment and Rehabilitation programs (CSTAR) are heavily relied on for out-patient treatment. Treatment exists on three levels of care ranging from once-a-week visits to daily visits lasting the entire day. The shift from in-patient services has had serious consequences particularly for the homeless population.

Preventative Partnership is a program designed to reduce drug, alcohol and tobacco abuse in selected neighborhoods. It is made possible by a five year grant from the Center for Substance Abuse Prevention. The premise is that collaborative planning can lead to the elimination of duplicative services and the filling of voids where there are no services. Those neighborhoods selected through a competitive process receive help from one of 17 staff members. Over the course of a year, conditions are examined, programs designed and implementation begun. Examples of specific initiatives include creating a TREND (Turning Recreational Excitement in New Directions) chapter; starting a neighborhood newspaper; addressing crime issues; establishing a coop business; creating support groups; conducting problem solving training; and more. Throughout, the emphasis is on having neighborhood participants define the appropriate projects and contribute to their implementation.

The Community Outreach for Risk Reduction Program is responsible for encouraging community-wide prevention and treatment programs for the HIV infected, alcohol and other substance abuse clientele; and those persons otherwise engaged in "high risk" for infection behavior. A primary goal is to provide the tools and knowledge, in a culturally sensitive way, for individuals in the community who are at particular risk of contracting or spreading HIV through intravenous drug use. Active outreach is provided for health education, along with testing, counseling and referral services. Their goal is to achieve the following short and long-term outcomes:

• An action plan for individual and community responses to HIV, other sexually transmitted diseases (STD's), and drug abuse epidemics.
• To foster a broader coalition and linkages in our community in order to combat these epidemics.
• Provide services and resources targeted to combat HIV disease and its related problems in our community.

Approximately 66 agencies/organizations have received HIV Prevention Education Presentations through this program.

Primary services provided by the National Council On Alcoholism and Drug Abuse (NCADA) include the following:

• Information and referral services including crisis intervention, short-term individual and family counseling, and referral to community treatment resources, practitioners, and self-help groups.
• 24-hour hot line
• Resource and Training Center
• Prevention Services such as K-12 prevention programming including the Regional Teen Institute on Substance Abuse (RTI), peer helping and education programs, High School Taught Element Program (HiSTEP), alcohol/drug free social and recreational activities (TREND), and elementary curriculum (WINNERS!), faculty and parent workshops, networking, technical assistance, and student assistance programs.
• Court Services including education, assessment and referral for persons arrested for driving while intoxicated and other alcohol/drug offenses are offered through the court services program. Services include a State approved Alcohol Related Traffic Offenders Program (ARTOP), and a program for persons with multiple alcohol/drug related offenses.
• St. Louis Area Employee Assistance Program is a division of NCADA and implements employee assistance programs in business, industry, and organizations. Services include counseling and referral, training, employee education, and management of mental health benefits.
• Advocacy and Community Development including sponsoring annual Alcoholism and Drug Addiction Awareness Month, an awards banquet, and a community luncheon.
• Community 2000 is a Missouri prevention initiative that supports communities in reducing alcohol and other drug abuse and related problems. Community 2000 is funded by the Missouri Department of Mental Health - Division of Alcohol and Drug Abuse which funds 12 Community 2000 Support Centers throughout the State. Their job is to assist communities in local prevention efforts.

NCADA is funded by United Way of Greater St. Louis and the Missouri Division of Alcohol and Drug Abuse. Additional support comes from foundation grants, individual and corporate contributions, memberships, fees, and contracts.

Since the shift from institutional settings to community placement seems to be on an intractable path, it is very important that the need for community placement is matched with the necessary support services and follow-up care. Many times the individuals of special needs groups are too frail or insecure to be totally self-sufficient. Without the proper matching services and housing customized to the needs of the individual, there is real potential that these individuals will become "stranded" and much of the work and treatment given these populations may be reversed and ultimately result in homelessness. Examples include Oxford Houses and Harris Houses which are privately operated and provide housing for recovering adults.

More services and resources targeted to combat alcohol and other substance abuse addiction, and related problems in our community are needed. The St. Louis Area National Council on Alcohol and Drug Abuse estimates that 5-10 people call daily and must be placed on waiting lists. The impact on the community however, extends far beyond these individuals. The community consequences of substance abuse include: 25-50 percent of hospital admissions involve substance abuse; divorce is seven times higher in substance abusing families; 37 percent of children of alcoholics grow up to be alcoholics; and 21 percent marry alcoholics. This problem begins and perpetuates a cycle of need for ever greater public services.

The needs of those agencies helping curb substance abuse are typical of many others involving health care. Services are fragmented and the reliance on publicly funded programs is increasing as private programs limit and exclude services. Although current health care reform provides some hope for correcting these problems, making services accessible is something that communities must support regardless of government funding. Those at the greatest risk to these shortcomings are often disadvantaged children and their families.

Implementing the following will help alleviate the needs not being met.

a) Establish a central referral system.

It is difficult enough for someone with a substance abuse problem to seek help without encountering difficulty in finding the proper place to go for help. The lack of a central referral system in the St. Louis area is extremely detrimental to the task of trying to help those with substance abuse problems find the proper help.

Experts in this area feel that the number of people who need help is far greater than the number of people actually seeking help. A central referral system would facilitate uniformity for those in need and in turn make it easier for them to contact the proper people for help.

Another benefit of a central referral system is that data collection with regards to the extent of the substance abuse problem will be possible. No one agency acts as a clearinghouse for service information so the extent of the problem is extremely difficult to quantify.

b) Provide more resources for programs such as Oxford Houses and Harris Houses.

Since the shift from institutional settings to community placement is the remedy of choice, support services and follow-up care are most important in rehabilitating substance abusers. Without proper services to counsel these individuals, community placement faces an overwhelming burden.

Providing substance abusers a place to live with supervision, as do Oxford and Harris Houses, helps customize the needs of the individual and guides them in their time of need. Funding to get these programs started face consistent difficulties. These houses are primarily supported by those who live there once they are in place thus reducing the tax burden (compared to alternatives) on the rest of society.

c) Increase funding for health services provided through State funded programs.

As services provided by private insurance systems decrease, the burden placed on state funded programs increases. The demand for these services is much greater than what is currently available. Access to these services has become more difficult in recent years, while greater awareness has increased the number of individuals seeking these services. State funded residential treatment programs have waiting lists with an average wait of four to five weeks. A crucial aspect of substance abuse treatment is getting individuals who seek services into treatment as soon as possible, while they are motivated and receptive to treatment, making this waiting period a significant problem.

Determining the amount of monetary resources being spent on substance abuse services in the City of St. Louis has proven to be impossible. Funding for health clinics, schools, and numerous other organizations and agencies is partially dedicated to substance abuse prevention and treatment.

According to the State Division of Alcohol and Drug Abuse, the amount of federal funding dedicated to substance abuse services in St. Louis City is $ , and the amount of State funds allocated for St. Louis City is $ . Beyond these figures, a realistic representation of funding within all other organizations which receive in whole or in part funds dedicated to servicing substance abusers is infeasible. Experts in this field do however, concur that the amount needed far exceeds the amount being spent on substance abuse services. An educated guess is that less than ten percent of the need for prevention and treatment is being met.

Current resources include foundation grants, individual and corporate contributions, membership fees and contracts, Partnership Prevention Grant, St. Louis Public Schools, the Housing Authority, and the St. Louis Police Department amongst others.