| St. Louis Five Year Consolidated Plan Strategy | |
| Issue Analysis Essay - Public Services | |
|
PUBLIC SERVICES/SOCIAL SERVICES
Within the past five years, many factors have affected the City's ability to meet the needs of its residents. The devolution of responsibilities to the states and local government, the effect of the balanced budget, and welfare reform will continue to place greater strains on the local budget. However, positive efforts including partnerships and collaborations, the increased role of faith-based organizations, and the contributions of the Danforth Foundation and the St. Louis Community Foundation have contributed greatly to the City's revitalization efforts. MAJOR THEMES Devolution of Responsibilities - Changes imposed by the devolution of responsibilities to the states and local governments has added an enormous burden on the already tight budgets of states and cities. The "Devolution Revolution," has resulted in a greater burden and more responsibility for programs that were previously seen as fundamental federal responsibilities. Since 1994, the devolution has entered an accelerated phase and state and local governments have even greater responsibility for welfare reform, job training, Medicaid benefits, and other social programs. This shift in responsibilities is not likely to be reversed soon and will continue to burden the city.1 Emphasis on partnerships and collaborations - Throughout the City, many positive changes have occurred because of partnerships and collaborations. The Empowerment Zone received commitments from more than forty organizations including government agencies, private businesses and non-profit organizations and institutions. The investment of these organizations involves discussions of as much as $2.5 billion. Another major collaborative initiative, St. Louis 2004, is developing initiatives that will provide regional solutions to the regional problems. The St. Louis Regional Jobs Initiative is a collaborative effort designed by more than 400 agencies, community groups, governments, and businesses. It is designed to prepare former welfare recipients for the work place and assist them in finding employment.2 Many other similar partnerships throughout the region are contributing to the revitalization of the City including ARCHS, Sustainable Neighborhoods, Caring Communities, and the Regional Report Card. Privatization - Privatization of public services has developed as a popular method to try to improve services. Throughout the country, privatization has been considered for many government functions including prison management, education, and street maintenance. Within the City of St. Louis, several functions have recently been privatized. In July 1999, the St. Louis Housing Authority began privatizing operations in an effort to improve its services. The Housing Authority has some experience in privatization with tenant-based management which it has used for many years. Some mental health services in the City of St. Louis have been also been privatized. The St. Louis Mental Health Center, which used to be operated by the Missouri Department of Health, is now operated by the BJC Health System. The privatization of the Metropolitan Sewer District was investigated but was rejected in favor of restructuring. Identification and replication of best practices - In 1997, the Pierce Report urged St. Louis to identify "best practices" in other cities and urged St. Louis 2004 to take the lead along with area universities. The City of St. Louis and many of the civic and neighborhood groups have taken this advice and continue to identify and replicate models that have worked in other cities. The City of St. Louis used a "best practices" approach in developing the Empowerment Zone projects and in planning projects in specific neighborhoods. Best practices have also been used by "Downtown Now," a public-private partnership, to help in planning their revitalization efforts and by SafeFutures to help with program planning. Welfare Reform and Welfare to Work - Welfare reform has had a disproportionate impact on many urban areas including St. Louis. The Brookings Institution Center on Urban and Metropolitan Policy studied the impact of welfare reform on low-income communities.3 Because a growing portion of the American poor are living in urban areas welfare reform will have a substantial impact on these neighborhoods.4 In 1996, the City of St. Louis had 6.6 percent of the state's population, but had 23.4 percent of the AFDC/TANF caseloads. Because caseload decline is linked to the extent of poverty in the city, the rate of caseload decline in St. Louis from 1994 to 1997 was only 57.2 percent as fast as the average for the state of Missouri.5 Role of faith-based organizations - Faith-based organizations have played a greater role in community and economic development. Thirteen churches, organized as RET--Reach One, Establish One, Teach One--have linked with the Small Business Administration to help transition TANF recipients to jobs and to identify new or potential entrepreneurs who can strengthen economic activity in the neighborhood.6 Effect of the balanced budget - Officials of all cities are aware of the impact of the federal balanced budget amendment. The Budget Reconciliation Act placed caps on the funding of programs, and projects such as the Empowerment Zone have not received the funding that was originally expected. The good economy disguises some problems that may occur in the future with welfare reform. If the economy slows and jobs become harder to find, there may be many unemployed people who have no support and the City will bear the impact. Contributions from the Danforth Foundation - The Danforth Foundation has contributed to the revitalization efforts of the City. It has shown interest in the 2004 project, Sustainable Neighborhoods, the Regional Report Card, child care programs, and the new Vashon High School and the surrounding community. Within the past few years, the Foundation has contributed funds to establish the Danforth Plant Science Center, to plan the refurbishment of Soulard Market, and to renovate an annex of the Sheldon Concert Hall. The Foundation also established the "I Dare You" award, which honors an area religious organization committed to working with the community, and donated $88,000 to support CommUnity, a grass-roots initiative on racism and other problems. St. Louis Community Foundation - The St. Louis Community Foundation serves the philanthropic needs of the St. Louis metropolitan area. The mission of the Foundation is to act as a catalyst in identifying and addressing community needs, while serving donors' interests. In July 1999, the St. Louis Community Foundation made a grant of $100,000 to the Regional Housing and Community Development Alliance. The grant will support the community-based planning process under the Sustainable Neighborhoods Initiative in four of the designated none neighborhoods. This planning process, conducted at the grass roots level by neighborhood leadership, is the preliminary step in revitalizing selected neighborhoods in the City, County and East St. Louis.7 HEALTH Health-care delivery - Both nonprofit and for-profit hospitals are increasingly put in a position of having to consider the bottom line when they treat patients and plan for expansion. Hospitals in the 1990s have gone through the merger and acquisition processes experienced by other institutions during the 1980s. Integrated delivery systems throughout the U.S. combine hospitals at different geographic locations (horizontal integration) and different types of care--primary, acute, and long-term (vertical integration). Many hospitals have expanded profitable programs while reducing services that are not profitable. HMOs and the government have forced medical-care providers to undercut each other to produce savings for consumers, investors, and taxpayers.8 This has resulted in many complaints about access to care and poor quality. ConnectCare - In 1996, the St. Louis region's only quasi-public hospital, St. Louis Regional Medical Center, lost its major source of funding and was forced to close. So, in summary, the city will no longer operate its own inpatient hospital services, but instead will purchase these services from BJC. Regional Medical Center, in the late 1990s environment, finally had lost its last significant relationship with any of the area's three major integrated delivery systems (obstetrics with BJC). Being on its own with only a modest census count, in a market with many empty beds at the three integrated delivery systems, was impractical, so the city decided to privatize - to steer, not to row. Also likely to be right alongside on the bridge, helping to steer, will be BJC. Sale of Local Hospitals - Because of the "bottom line" approach forced on hospitals, institutions such as St. Louis University Hospital were forced to balance their commitment to patient care against the survival of their medical education and research programs in deciding to sell the hospital.12 St. Louis University Hospital was one of many community hospitals that were sold to Tenet Health Systems, a for-profit California company. Tenet had previously bought the Deaconess Hospitals and merged themselves - including Deaconess Central Hospital, Lutheran Medical Center and Lafayette Grand Hospital. Changes at the St. Louis Health Department - On Mayor Clarence Harmon's first day in office in April 1997, he fired Dr. Kathryn Vedder, the director of the St. Louis Health Department. During Vedder's tenure, many problems had developed. Questionable travel costs for Vedder and the staff were incurred at a time when money for basic services was scarce, the tuberculosis control program failed to read hundreds of chest x-rays and lost records of infected patients, and the city ambulance service had slow response times and failed to bill for $11 million in services.13 Dr. Larry Fields was appointed interim director and eventually the permanent director. Fields cleared up the backlog of x-rays, completed an independent audit of billing practices, and started a more rigorous financial oversight.14 Medicaid Expansion - The Medicaid expansion bill that was passed in Spring 1998 will be tremendously beneficial in protecting the health of area children. About 90,000 of the 160,000 Missouri children who were without health insurance can now get Medicaid coverage. This bill allows families of four earning up to $49,350 to purchase subsidized health insurance through Medicaid. This is one of the broadest, most progressive plans in the country.15 The city's (and the county's) lowest income children, and their mothers, who are eligible to be Medicaid recipients, have been covered for the past four years by MC+, the state of Missouri's Medicaid managed care program. Organized like similar programs in most other states and authorized by federal waivers, MC+ entry into the Medicaid market has led to the development of five networks of insurers, and acute and primary care providers (including, in some networks, the traditional federally qualified health centers--FQHCs--which have served the poor in the city) competing to be selected by these Medicaid families. The state has to juggle incentives to keep the best networks participating (e.g. low visibility for quality assurance measures) with a sufficient level of accountability to justify the states withdrawal from its previous role as the direct reimburser of Medicaid providers. ELDERLY The elderly face an enormous array of problems and the burden on the cities and states will continue to grow in coming years as the huge number of baby boomers age. Seniors over 60 years of age now represent 21 percent of the City's population compared to approximately 12.5 percent of the U.S. population. Approximately 17 percent of the City's elderly live below the poverty level compared to a national rate of slightly more than 12 percent. Some of the general trends for the elderly are discussed below. Increased life expectancy - Life expectancy for all Americans has continued to increase throughout this century. The average life span has increased from 47 years in 1900, to 68 years in 1950, to 76 years in 1991. Because of increased life expectancy, the most rapidly growing elderly age group are the "oldest old," those aged 85 and older. In the United States, the oldest old numbered 3 million in 1994, making them 10 percent of the elderly and just over 1 percent of the total population.16 In the City of St. Louis, however, those over 85 years of age comprised a greater portion of the population even in 1990. According to the 1990 census, those over 85 years of age comprised 12.7 percent of the City's elderly and more than 2 percent of the total City population. Life expectancy varies by sex and race however. For women in the United States, the average is 79 years while for men, the average is 72 years.17 However, the life span for whites is greater than for Blacks. By 1992, the life expectancy for Black women in the U.S. was 74 years while the life expectancy for White women was 80. White men had an average life span of 73 years while Black males averaged only 65 years.18 In the City of St. Louis, a male African American born in 1990 has an average life expectancy of just over 59 years--15 years less than the average for all Americans.19 Increased growth of the elderly population - The elderly who comprised only one in every 25 Americans (3.1 million) in 1900, made up 1 in 8 (33.2 million) in 1994. Within the city of St. Louis, however, the elderly comprised more than 1 of every five people as of 1990. According to census bureau projections, the elderly population will more than double between now and the year 2050, to 80 million. The average annual growth rate is expected to be 1.3 percent from now through 2010, at which time it is expected to increase at a rate of 2.8 percent per year.20 Poverty and median income variations - There is a great variation among elderly subgroups. In 1992, the poverty rate was 15 percent for those under age 65, but rose with age, from 11 percent for 65 to 74 year olds to 16 percent for those aged 75 and older. In the City of St. Louis, the poverty rate was higher, with 17 percent of those aged 65 and over living in poverty. Elderly women in the United States have a higher poverty rate than men (16 percent versus 9 percent respectively). Elderly Blacks have a poverty rate of 33 percent, while Hispanics have a poverty rate of 22 percent, and Whites have a rate of 11 percent. Elderly white men have much higher median incomes than other groups. In 1992, their income was more than double that of elderly Black and Hispanic women ($15,276 versus $6,220 and $5,968 respectively). The difference in median income between Black and Hispanic women was not statistically significant.21 Housing problems - Poverty leads to many other problems with housing concerns being a major issue. Mike Nickel of the St. Louis Department of Human Services, Division of Aging believes that home repairs are now the major problem many senior home-owners face. Because they do not have enough money to pay for minor repairs, the minor problems continue until they result in major problems. Home Security (formerly Senior Home Security) provides assistance with minor home repairs and has 1,500 people on the waiting list. The waiting would be much longer if it was not cut off at 1,500. More people facing dependency - As more people live to the oldest ages, there may also be more who face chronic, limiting illnesses or conditions. Dependency often results from conditions such as arthritis, diabetes, osteoporosis, and senile dementia. These result in people becoming dependent on others for help in performing the activities of daily living.22 The number of frail elderly is expected to grow dramatically over the next decade. Changes in Medicaid and Medicare - For those needing nursing home care, Medicaid reimbursements rates are a factor. Although long-term care reimbursements have been increasing, the rate of increase has been declining. This forces people to look for alternatives such as in-home care or community services. However, Medicare regulations and payment caps put pressure on home health care organizations to constrain costs and many health care organizations are not surviving. Home health care, in fact, is one "product" of the vertically integrated delivery systems. And it also is important to note that commercial insurers are withdrawing from their Medicare managed care contracts, when they prove to be insufficiently profitable. Elderly Education - St. Louis is the home city of the OASIS Institute, "providing learning opportunities for mature adults," and now, they say, reaching 340,000 adults in 28 cities. Supported in each city by the local May Department Store and a local hospital, OASIS in St. Louis works on intergenerational volunteer programs with school children and will inaugurate here an NEH-funded program on the recent history of the peoples of Russia and China. EDUCATION Within recent years, there have been substantial changes that affect the public education in the City of St. Louis. Ballot victories allowing new capital improvements and changes in the desegregation plan will change the facilities and the delivery of education for many students. In addition, state certification of teachers and concern over student test scores continue to be issues for the system. Capital improvements - Through a capital improvements plan begun in the late 1980s, 99 school buildings were renovated and six new buildings were constructed. Three new schools opened in 1995, three opened in 1996, and one opened in 1997. The new schools are as follows:
Enrollment in the public school system increased for three years beginning in the 1995-1996 school year and then leveled off. Increased enrollment may be attributable to the initiation of additional preschool programs. Enrollment figures are shown below: Year Enrollment 1995-1996 41,711 1996-1997 42,511 1997-1998 45,819 1998-1999 45,450 (Source: SLPS Annual Reports) Desegregation changes - In February 1999, City voters approved a sales tax designed to help end school desegregation. The most common reasons for a "yes" vote on this issue was that it would strengthen neighborhood schools, and voters were signalled by the federal courts that city children's interests best would be served by that "yes" vote given what the courts alternatively might do. Voters who were interviewed also indicated a clear preference for having students attend schools near their homes.23 The new law also returns control of the schools from the federal courts to the local school boards. However, schools are now faced with the task of improving achievement at the same time that they have $7 million less each year. The sales tax will provide $23 million a year for city schools and will trigger about $40 million in state aid, but this falls about $7 million short of the amount that is received through the desegregation plan.24 Also, city school enrollment is expected to increase because of fewer transfers to St. Louis County. Low test scores - Low test scores, particularly on the Missouri Assessment Program (MAP) test, continue to be an issue and will be an important factor in the accreditation process for the school system. Recent studies show a clear link between family income and students' test scores. There are many possible explanations for the correlation including:
There are a number of city schools targeted for improvements and special assistance because of low test scores. As part of the desegregation settlement, the number was increased from ten to forty. 26 Dropout rates and graduation rates - The most recent Missouri School District Report Card shows city school enrollment of 44, 442 with an annual dropout rate of 16.2 percent and a graduation rate of only 38.6 percent. This compares to statewide averages of 5.5 percent and 76.3 percent, respectively.27As with test scores, research indicates that economic status rather than race or ethnicity is the surest predictor of dropping out. 28 Accreditation - The accreditation process for the public school system began on March 8, 1999. The review focused on many factors including class size, scores on the Missouri Assessment Program test, teacher training and certification, and the nutrition of the cafeteria meals. A recommendation on whether the schools should be accredited will probably not be made until the fall of the year. If they are not accredited or if they receive a "provisional accreditation" the district would have the remainder of the 1999-2000 school year and two additional years to show improvement. If they remained substandard after that period, the State Board of Education probably would call for a transitional school board.29 SUBSTANCE ABUSE Substance abuse continues to be a contributing factor to many problems in the state of Missouri and the City of St. Louis. According to the Missouri Division of Alcohol and Drug Abuse, alcohol and other drug abuse affects more than 259,000 Missourians directly as substance abusers and another 800,000 Missourians who are family members of substance abusers. The toll is measured in both human and economic terms. Substance abuse contributes to domestic violence, the break-up of marriages and families, and lost productivity on the job and in school. It afflicts more than half of all persons incarcerated for committing crimes in Missouri. Alcohol intoxication is a cause in a large portion of deaths from burns, fires, homicides, assaults, drownings, suicides, and traffic crashes. Some of the recent trends are discussed below. Legal drugs - Legal drugs still kill far more people in Missouri and around the country than illegal ones. Last year, 363 alcohol-related deaths were recorded in the state--about twice the number caused by all categories of illegal drugs combined. In 1997 in the City of St. Louis, there were 400 alcohol-related auto crashes. More than 6,500 people were hospitalized for problems that were caused by alcohol.30 A recent survey commissioned by the St. Louis Mental Health Board reported that 32 percent of the families in the City of St. Louis have experienced alcohol abuse.31 Although the statistics for alcohol-related problems are high, the numbers pale in comparison to tobacco. Tobacco accounts for one of every five deaths in Missouri and treatment for people with emphysema and lung cancer exact a costly toll each year.32 Illegal drugs - The City of St. Louis showed little change in overall drug use in recent years. While there was a decrease in some drugs including crack cocaine and marijuana, there was a substantial increase in the use of heroin. Therefore, there was not a major improvement in overall drug use. Heroin has become Missouri's deadliest illegal high. From 1992 to 1997, the number of people trying to kick their heroin habit nearly tripled in Eastern Missouri. During the same time period, admission to treatment programs grew by 672 percent.33 One factor in the increased usage is the decrease in price. Although heroin prices have fallen throughout the country, in St. Louis, the price of heroin fell about 70 percent from 1991 to 1995.34 Other factors cited for the increase include new ways to take the drug, increased purity, lack of education about its dangers, and heroin's chic image.35 The National Institute of Justice speculates that St. Louis may be building a large opiate using cohort of the magnitude that Chicago, Manhattan, and Portland have experienced for generations. Drug use and crime - According to the Missouri Department of Corrections, drug use among those who are arrested is significant. In St. Louis, 74.1 percent of male adults who are arrested tested positive for drugs. The increase in heroin use leads to increased theft. Heroin users start out paying $10 for a "button" but soon end up spending $100 to get the same effect. To pay for the drugs, users often steal.36 Increased treatment availability for convicts - Prior to 1993, there were only 562 short-term institutional substance abuse treatment beds available at three institutions for men. No long-term drug programs were available for men or women. There are now more than 2,800 institutional beds providing short- and long-term treatment to both men and women at ten facilities across the state. The Department of Corrections in partnership with St. Louis City has established drug courts, and shock-incarceration initiatives to target drug-involved offenders. Because of state and federal programs, the number of offenders returning to the Department of Corrections with a new felony offense has dropped from 34 percent in 1993 to 21 percent in 1999.37 For example, the city also is a site for the national experimental program Opportunity To Succeed which focuses on follow-up services for offenders with drug problems and is managed locally by Lutheran Family Services and the state office of probation and parole. Continued need for treatment - It is estimated that more than 259,000 Missourians are in need of treatment services. The cost of a drug or alcohol dependency that goes untreated is enormous. Alcohol and drug abuse cost the state of Missouri more than $3 billion per year in lost productivity; about one fourth of all costs incurred by law enforcement agencies are related to alcohol and drug abuse, and more than a fourth of all patients in hospitals are being treated for illnesses or injuries related to their substance abuse. It is estimated that for every dollar spent on treating an individual with substance abuse, $12 in future costs to society are avoided. Yet only 25 percent of the dollars expended to fight substance abuse goes to prevention and treatment. Low funding for treatment programs results in waiting lists or a lack of aftercare and follow-up. Only 15 percent of addicted individuals will receive treatment in the coming year.38 CRIME Although crime is often stated as a major concern for City residents, St. Louis has experienced decreases in crime rates and the residents perceptions often do not reflect reality. Some of the recent trends are given below. Total crime nationwide dropped 4 percent from 1996 to 1997 while St. Louis showed a 9.3 percent drop. This decrease is part of a decreasing crime trend that has existed since 1993. In the City, from 1993 to 1998 total crime dropped slightly more than 20 percent. Serious crime has also fallen sharply. In 1998, St. Louis had the lowest number of homicides since 1964. Juvenile crime has also fallen sharply; this decrease is usually attributed to the decline in crack cocaine. Drug abuse and crime are intertwined - Three-fourths of the people incarcerated in Missouri have a substance abuse problem and 90 percent of them said they were under the influence of alcohol or other drugs at the time they committed their crimes. About a fourth of all costs incurred by law enforcement agencies are related to dealing with alcohol and other drug abuse. Studies also show that crime rates are reduced by 80 percent in the first year among those who have completed treatment programs.39 Efforts to reduce substance abuse would also go a long way in reducing crime. Although the City of St. Louis is often reported to have a high crime rate, police officials believe that the ranking is not an accurate picture of crime in the city. Approximately 50 percent of the crimes in the city are larceny which includes the theft of auto license tags. The theft of auto tags is a persistent problem in major cities in Missouri where the tags are valuable. Theft of the tag allows the thief to avoid the cost and expense of getting licenses renewed, vehicles inspected and cars registered.40 The number of American adults imprisoned has more than doubled over the past twelve years. By mid-1998, jails and prisons held approximately 1.8 million men and women. However, the racial composition has remained unchanged for the past decade--41 percent white, 41 percent black, 16 percent Hispanic, 2 percent Asian and Native American. When adjusted for their numbers in the population, blacks were six times more likely to be incarcerated than whites.41 Because of high rates of incarceration, Missouri is completing a $400 million prison-building campaign, though some fear that the additional new space may not be enough.42 A crime bill approved by the Missouri legislature in Spring 1999 is designed to trim the prison population by urging judges to follow sentencing guidelines set by the 11-member Sentencing Advisory Commission. Judges are also encouraged to order more criminals to take part in "restorative justice programs" such as work-release, community service, drug treatment and victim restitution.43 YOUTH Within the City of St. Louis, there are approximately 89,900 children under the age of eighteen--about 25.5% of the population. These children face enormous challenges caused by poverty, health-related issues, crime, poor neighborhoods, and a variety of other factors. Poverty or lack of income is a major factor for most of the children in the City. More than 50 percent of all the school-aged children in the City are living in poverty and more than 89 percent are enrolled in free/reduced lunch programs.44 In 1996, there were more than 60,300 persons on federal welfare, including 19724 families and 43,650 children.45 In 1995, it was estimated that in ten City zip codes, over 50 percent of the children were at risk for hunger.46 As stated above, economic status has been shown to be the primary factor in low test scores in school as well as the greatest predictive factor in high-school drop-outs. Thus, children from low-income families are likely to do poorly in school and in turn be unable to earn a good wage when they are adults. As stated above the Medicaid expansion bill that was passed in Spring 1998 will be tremendously beneficial in protecting the health of area children. About 90,000 of the 160,000 Missouri children who were without health insurance can now get Medicaid coverage.47 However, there are still many children who are not insured who will not receive adequate medical care.
Although juvenile crime has decreased, efforts are still needed to address this issue. In 1997, Attorney General Janet Reno called for more money for after-school crime-prevention programs since most violent juvenile crime occurs between 2 p.m. and 8 p.m. Several programs in the City have been established to address high-risk teens and juvenile crime. Project Respond manages the City of St. Louis SafeFutures program, a federally funded partnership aimed at reducing youth violence and delinquency. Project Responds Pilot Educational Program (PREPP) serves high-risk youth who are at risk for delinquency, gang involvement, school failure, and other problems. Many neighborhoods are not conducive to proper child development. Many zip codes have a high percentage of vacant housing and buildings that are condemned. The problem of lead poisoning is caused by old housing stock that contains lead paint even though lead paint has been banned for 20 years. Living conditions for many of the area's poor are substandard. Waiting lists for admission to public housing and Section 8 assisted housing are so long that many families do not even apply.49 Child care is a problem for many low-income residents. Average child care costs are roughly $4,000 per child per year and is often the second or third biggest item in their household budget. Programs that offer sliding scale fees or subsidized care serve only a fraction or the children who need services. As a result, too many children spend time in make-shift, temporary arrangements. In July 1999, Missouri's laws which regulate day care were strengthened. Prior to that time, only workers in licensed centers had to submit to background checks. The new law requires that any care giver (including unlicensed centers such as those run by religious organizations) receiving state payments must submit to background checks. The new law also releases federal food money to license-exempt child care centers for the first time. Thus, the number of Missouri children who will benefit from food reimbursement will increase from 49,000 to 78,000.50 Zero Population Growth recently rated cities as to whether or not they were "Kid friendly." Factors considered included the population decrease, teen births, crime, the number of children living in poverty, and air quality. St. Louis was ranked as one of the worst cities for raising children.51 EMPLOYMENT Low- and moderate-income St. Louisans face many barriers when trying to find employment in the private sector. In addition to a lack of job skills, these individuals must often overcome problems with transportation, day care, low self-esteem, and many other factors. Within the City of St. Louis, many initiatives have been implemented in recent years to assist low- and moderate-income individuals in finding employment. Some of these innovative programs are described below.
ENDNOTES
|