Purpose

The Community Assessment Committee of The United Way in Marin is charged to research and gather information about community needs, as well as community assets. The Committee was given a three-month time period to gather information to supplement the 1995 Needs Assessment document. The purpose of the supplemental document was to educate The United Way in Marin's fund distribution committee, as well as inform community organizations and individuals of the recent trends in the County.

The 1995 Needs Assessment is considered a living document to be continuously updated. The Community Assessment Committee determined that a supplement to the 1995 Needs Assessment would be beneficial to the Allocations Committee. This supplement is designed to inform the Allocations Committee in three primary areas: (1) changing needs due to changes in the community, (2) emerging needs due to 1996 Welfare Reform legislation, and (3) areas of need not funded by the Community Impact Fund in the previous year's grant cycle.

Long-term goals of the Committee include updating the 1995 Needs Assessment, researching and adding information in areas not previously addressed within the document, continuing to report on trends and emerging needs within the community, and assessing the assets within a designated community.

Community Assessment Committee Members

The Community Assessment Committee consists of nine members. Volunteers were chosen with a variety of expertise, skill, background, areas of interest and professional experience. It is a priority of The United Way to support collaboration between agencies; therefore, it was intentional that the Committee was inclusive in recruiting volunteers who represent other funding agencies within the County.

Methodology

The Community Assessment Committee reviewed the 1996 Priorities and Principles of Funding developed by The United Way in Marin and recognized their continued appropriateness. The Committee then studied the 1995 Needs Assessment, identified data gaps in the document and discussed emerging changes within the community. The Committee created a framework of issues to study. The framework began with three major topics of study: (1) welfare reform, (2) areas of need not funded by the Community Impact Fund 1996/97 grants, and (3) changes in the delivery of services in the County.

Within this framework, the issues that emerged are as follows:

• Implications of Welfare Reform

Education, Employment and Training

Immigrant Eligibility

Elderly/ Supplemental Security Recipients

Food Stamps

Health Care

Prenatal Care

• Area of Need not funded by the Community Impact Fund 1996/1997 grants

Substance Abuse

• Changing Needs due to Changes of Service Delivery within the County

Homelessness

Background

Temporary Assistance for Needy Families, TANF, (the government assistance program replacing AFDC) requirements are creating enormous pressure on individuals and families to become economically self-sufficient through employment. Some of the requirements of concern are:

1. time limits on the length of time a family can receive government assistance;

2. requirements for participation in employment and training programs; and

3. stricter eligibility requirements, particularly for immigrants, but potentially affecting all recipients.

Many elements combine to support a person's ability to become successfully employed or self-employed. Education, training, knowing and successfully negotiating the culture of work in our community (including language, dress, behavior, and attitude), and having the skills to seek, gain, and maintain employment, are all vital in becoming successful in today's work world.

Other factors contribute greatly to a person's motivation and ability to successfully participate in work. Having adequate and affordable housing, suitable child care, being free from alcohol and substance abuse problems, having access to affordable medical care and mental health services, having transportation linkages to employment, and having basic food and nutritional needs met, are all elements that support the ability of individuals and families to become self-sufficient through work.

Existing employment and training services in Marin will be critically tested, in both capacity and service structure, to respond to the quickly growing need for people to gain skills that will enable them to find and keep jobs and/or develop income generating business. Other institutions that support a person's ability to participate in work and related activities (for example, access and participation in community college, English as a Second Language, and adult education) may also be severely stressed.

With the pressure for people to participate successfully in the world of work comes the increasing need to link employment related services to business and economic development. New and existing partnerships between business, government, education, and human services must be nurtured. Sustainable economic development and social needs planning must be addressed collaboratively.

Areas of Concern

The Community Assessment Committee recommends that careful consideration be given to funding proposals in areas that support the ability of individuals and families to become income self-sufficient, including:

Health Care

Alcohol and Substance Abuse

Mental Health

Food Programs

Transportation

Immigrant Services

Child care, also a critical element in families' ability to work, should be monitored. (Funding for child care is more adequately addressed than other issues in the TANF legislation.) Housing is also of critical importance and is addressed elsewhere in this report.

The Community Assessment Committee further recommends that special priority be given to supporting proposals that address more than one priority area and are linked with education, training, and employment services.

Background

As a result of the recently enacted Federal Welfare Immigration Reform Bill, many immigrants who are currently receiving some forms of public assistance will be ineligible for those services in the future. The County of Marin Department of Health and Human Services have identified about 2,100 non-citizen immigrants who will suffer hardship from this Reform Bill.

Areas of Concern

• Support organizations which are currently providing naturalization assistance and expand their capacity to serve more citizenship candidates.
• Identify communities and individuals who need citizenship services.
• Support civic classes to assist those individuals with language or cultural barriers.
• Train and recruit more citizenship instructors.
• Sponsor "Citizenship Fair" throughout the year to make naturalization information readily accessible.

Background

The fastest growing segment of Marin's population is those persons 75 years of age and older with an annual growth rate of approximately 5 percent. Many of these older individuals have low incomes. Some are on Supplemental Security Income (SSI). The median income for Marin residents over age 75 in 1990 was $16,000. The high correlation between advanced age and increased functional disabilities means that we can expect an intensified demand on health and social services and a greater strain on the community's resources.

While the overall percentage of minority elderly in 1996 was only 8% (3,359 persons), of those persons 60 years of age or older, the rate of growth of multi-cultural elders in the past six years is three times faster than the growth rate of Caucasian elders. Many of these persons are recent immigrants and will be directly impacted by the cutback in eligibility for public benefits such as SSI, food stamps, and MediCal.

Areas of Concern

• Programs which provide services to minority and low income elders, particularly services which support older, more dependent persons.

• Programs which support caregivers. Family members and friends unquestionably provide the lion's share of care to the elderly. Frequently, these caregivers continue caring for dependent family members until their own mental and physical resources are drained. With a little professional support, they are able to be much more effective care-givers.

Background

Because of the 1996 Welfare Reform legislation, California stands to lose 6 to 10 billion dollars in federal funds over the next 5 years. Half of the law's spending reductions come in the food stamp and nutrition programs.

The new welfare law requires states to terminate food stamps after three months in any 36 month period to unemployed, work-abled individuals who are not raising children or participating in certain kinds of employment and training programs. Immigrants are not eligible for food stamps, and benefits will be reduced for everyone (benefits cut to an average of 66 cents per person, per meal).

The individuals without children who are able to work include a large number of persons (30%) over the age of 40. Some 41% of these persons are poor women. Unemployed individuals over 40 who have limited job skills often have more difficulty finding jobs. Few remain on food stamps continually. But a majority take more than three months to find a job.

In 1996, 3,284 households in Marin (6,277 persons) were receiving food stamps. Food stamps are an essential component of income supplementation to low income families.

Areas of Concern

• In areas of need such as food and nutrition, it is unrealistic to expect that The United Way funding can fill gaps where federal funding is reduced. Therefore, funding public policy or advocacy programs may be an alternative strategy.

• Food vouchers and/or nutrition and food programs to be available to low income families, unemployed work-abled adults, unemployed persons needing more than 3 months to find a job, and immigrants.

• Culturally sensitive, work placement, employment and training programs to allow individuals to continue receiving food stamps to supplement their low income.

Background

HR 3734, the Personal Responsibility Work Opportunity and Medical Restructuring Act of 1996, specifically eliminates entitlement programs for most current and future legal immigrants, as well as undocumented persons. Only those legal immigrants who are already here who are veterans, who are refugees and those granted asylum, as well as those who have worked for 10 years, will continue to be eligible for Medi-Cal. Other legal immigrants who are already here -- those with limited or no work history -- may be covered if the state enacts laws to cover them (using state dollars). Individuals who enter the United States legally after August 23, 1996 will be ineligible for food stamps, SSI cash assistance, and non-emergency Medicaid for the first 5 years.

As of January, 1997, California must choose whether it will use state funds for any services for non-citizen legal immigrants. Undocumented immigrants continue to be restricted to emergency Medicaid coverage only. Currently, California funds several programs with 100% state money that are used by citizens, legal and illegal immigrants, including CHDP (well care for children), EAPC (tobacco tax funds for primary medical care), and family planning services for low income women.

Most of the changes are to be implemented by July, 1997, although the state has the option to implement them more rapidly. However, the changes will be gradual, coming at the next scheduled eligibility review for the family. For legal immigrants, the earliest Medi-Cal benefits would begin to be cut is January, 1997. The future and timing of legal immigrants' access to state funded programs is still unknown.

There are many demographic factors to consider:

• High levels of immigration recently, resulting in cultural and linguistic isolation for immigrant populations.
• Increasing numbers of elderly persons, many with either mobility and/or self care limitations, living alone, and with limited financial resources.
• High numbers of violent crimes and increased reporting of domestic violence and related services utilization.
• High numbers of deaths to persons under 35 years of age attributable to unintentional injuries, AIDS, and suicides.
• Increased family stress resulting from the economy, the growing prevalence of violence in the society, traffic and congestion, and unique stresses present in immigrant families (e.g. minority group status, cultural conflict, adjustment to immigration, refugee history and economic struggle).
• Identification of substance abuse as a major health issue for youth in particular and a high rate of alcohol use and drug-related deaths.
• High incidence rates for AIDS and Tuberculosis.
• High breast cancer mortality rates.
• Higher rates of adolescent pregnancies for Hispanics.
• Significant barriers to access to health care services (i.e. economic, cultural, linguistic) for select population groups despite a wealth of hospital resources.

Areas of Concern

• In areas of need such as Health Care, it is unrealistic to expect that The United Way funding can fill gaps where federal funding is reduced. Therefore, funding public policy or advocacy programs may be an alternative strategy.
• Support for health services for undocumented residents.
• Support for health services for legal immigrants.
• Support for programs which reduce the barriers to access to health care.
• Support for modification and expansion of substance abuse services to better serve non-white residents.

Background

Currently, California funds perinatal care for undocumented women, which is more than is required by the new federal law. Illegal immigrants face the most immediate changes in the areas of prenatal care, which provide both regulatory and funding challenges. On the funding side, this year's state budget contains only six months of funding for prenatal care, which sunsets on December 31, 1996. The legislature is not slated to meet until January, 1997. On the eligibility side, welfare reform law requires that states reenact legislation to fund care with state-only funds.

Although legal challenges may delay implementation of the prohibitions in the welfare reform law, funding might be interrupted, at least temporarily and perhaps long term. At the minimum, over the next few months, public notice will probably be given to patients, and a public comment period will open, preparatory to ending benefits.

Factors to consider:

• Data from Marin County Birth Certificates in the period from 1990 to 1996 indicate that while the number of prenatal care visits increased for all births, it increased less for births in which the prenatal care was paid for by Medi-Cal and for those with no insurance.
• For births to mothers under 20 years of age at the time of birth, the percent of mothers who began prenatal care later in their pregnancy has risen in the past three years, as has the percent of low birth weights among those births.

Areas of Concern

• Continued funding of comprehensive prenatal care for undocumented residents.
• Continued funding of comprehensive prenatal care for legal immigrants.
• Continued funding of comprehensive perinatal outreach, especially to Hispanic teenagers.
• Substance abuse/mental health program services for prenatal and post partum interventions.
• Continuing substance abuse/mental health counseling beyond post partum period.
• Targeted pregnancy prevention services, including outreach, counseling, and case management for Hispanic teenagers.

Background

Public funding of alcohol and other drug prevention and treatment services in Marin County has declined in the past five years. The resulting decrease in services has created significant demand on existing resources and limited the ability of providers to respond to new and emerging needs. Additionally, disabled individuals who have been eligible for SSI based primarily on a substance abuse problem will lose eligibility effective January, 1997.

Areas of Concern

The Community Needs Committee identified substance abuse as the one program area that did not receive United Way funding in Marin County for 1996-97. Acknowledging the significant impact that alcohol and other drug abuse has on the quality of life in our community, the Community Needs Committee recommends consideration of the following special populations and needs in the area of substance abuse:

• Prevention, outreach and treatment services aimed at responding effectively to the needs of:

Latinos

Asians

Elderly

Dually Diagnosed (mental/health/substance addiction)

Youth

Marin City Residents

Background and Findings

The number of homeless people and those in danger of becoming homeless in Marin has nearly doubled over the last decade. It is estimated that a minimum of 2,500 Marin residents experienced an episode of homelessness in 1995. As of 1994, there were 120 year-round shelter beds, 220 seasonal shelter beds, and an estimated daily homeless population of 250, resulting in a shortage of between 30 - 130 beds per night.

Federal budget cuts are increasingly putting the burden of homeless programs on individual counties.

Most homeless programs focus on homeless clients that have the greatest likelihood of being reintegrated into the mainstream. Homeless individuals with substance abuse problems or mental illness are not eligible for many of the programs currently in place. Fewer dollars and programs (e.g., there are no longer any detox beds available in the county) are available for the chronically homeless.

Areas of Concern

• Support programs for homeless persons that address substance abuse and mental illness as well as dual diagnosis (individuals with substance abuse and mental illness problems).
• Support programs which focus on chronically homeless persons.

DRAFT

January 8, 1997