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1977-11-08 Info Packet
• ity of Iowa Cit • MEMORANDUM DATE: November 4, 1977 TO: City Council FROM: City Manager RE: Collective Bargaining Previously we have discussed with the City Council a desire to consider public -open bargaining sessions and independent impasse procedures. The City and Fire Fighters Local 610 have agreed to public -open sessions. The City and AFSCME Local 183 have agreed to independent impasse procedures. In accordance with the attached agreement, the arbitrator's authority is limited, a February 15 deadline is established, impasse is provided for only mandatory items, fact finding is eliminated, and realistic dates for imple- mentation of the process are provided. Z163 7 IMPOSE PROCEDURE FOR LOCAL 180 AND THE CITY OF IOWA CITY AND THE LIBRARY BOARD OF TRUSTEES FOR CONTRACT BEGINNING JULY 1, 1978 In the event the City/Library Board of Trustees and Union have not reached an Agreement by the November 15 immediately preceeding the June 30 expiration date of this Agreement, the following procedure shall be followed: a) On or before November 15, 1977, each party shall provide written notice to the Federation Mediation and Conciliation Service Office at Cedar Rapids, Iowa, of their bargaining relationship and request appropriate assistance through the mediation services of that office. b) In the event an Agreement has not been reached by January 4, 1978, the parties will meet to select an impartial arbitrator. Should they be unable to mutually agree upon such arbitrator, they will immediately jointly request the Public Employees Relations Board to provide a panel of five (5) qualified arbitrators from which one (1) will be selected through the process of alternate strikes. c) In the event the parties have not reached Agreement by January 16, 1978, they shall within four (4) days notify in writing the arbitrator previously selected certifying to such arbitrator each mandatory issue upon which impasse has been reached and the respective final proposals on same. Other matters mutually agreed upon in writing may be sub- mitted to the arbitrator. The arbitrator shall consider, in addition to any other relevant factors, the following factors: a) Past collective bargaining contracts between the parties including the bargaining that led up to such contracts. b) Comparison of wages, hours and conditions of employ- ment of the involved public employees with those of other public employees doing comparable work, giving consideration to factors peculiar to the area and the classification in- volved. c) The interests and welfare of the public, the ability of the public employer to finance economic adjustments and the effect of such adjustments on the normal standard of ser- vices. d) The power of the public employer to levy taxes and appropriate funds for the conduct of its operations., -z- 0 The arbitrator may hold hearings and administer oaths, examine witnesses and documents, take testimony and receive evidence, issue subpoenas to compel the attendance of witnesses and the production of records. Tito arbitrator may petition the district court at the seat of gbvornment or of the county in which any hearing is held to enforce the order of the arbitrator compelling the attendance of witnesses and the production of records. The decision of the arbitrator on each impasse issue shall be rendered in writing on or before February 15, and shall be binding upon the parties unless contrary to law. The fee and expenses of the arbitrator and all other costs shall be shared equally. 1477 Dated thisday of *City o4 Iowa Cit* MEMORANDUM TO: City Council FROM: RE: DATE: October 18, 1977 Dennis R. Kraft, Director of Community Development,i��i-7J Housing Assistance Plan PAcRCT Each year the City is required to submit a local Housing Assistance Plan which is prepared as part of the Community Development Block Grant. The Plan includes a statement of housing needs with data summarizing the needs of lower income people and a statement of what the City plans to undertake in order to meet the need for housing among lower income people. This year the City is fortunate to have received a number of new housing allocations from HUD that we did not foresee last January when the Housing Assistance Plan was prepared for FY 178. It is therefore necessary to submit a revised Housing Assistance Plan reflecting and justifying these additions on our current and three-year goals statement. 229 of the possible 279 housing unit allocations for Iowa City are for the elderly and handicapped segment of the population. This substantial proportion for elderly land handicapped does not correspond with previous HAP percentages of need, however, it does correspond with the revised HAP needs study in progress at the time alloca- tions were made. The new needs study, undertaken with a valid and clear methodology will be submitted with the revised goal statements for FY 178 Two recent reports, the Exterior Building Conditions Survey and the Report on Housing for the Comprehensive Plan, were also used in clarifying needs for low income housing in Iowa City. The update revealed the following information. Numbers of households in need of assistance: A. Elderly and handicapped households (1-2 persons) 1,434 B. Small family households (4 or less non -elderly persons) 974 C. Large family households (S or more non -elderly persons) 96 According to the HUD specified Housing Assistance Plan format, there are several alternatives cities can use in order to meet the demand for low income housing reveal- ed in a needs statement. These include construction of new rental units, rehabilita- tion of rental units, rental assistance in existing units, rehabilitation assistance to homeowners or prospective homeowners, and new construction assistance to homeowners or prospective homeowners. The attached discussion outlines what the City staff is proposing for Iowa City in the amended Housing Assistance Plan for FY 178. Some of the needs for low income housing in Iowa City can also be solved through the private market, and staff is not necessarily committed to providing housing through each of the categories listed by HUD. However, in the event that alternatives in the private market do not materialize, federally assisted housing programs will have to be used. There must be some clear statement of the expected use of federally assisted housing programs on FY 178 Housing Assistance Plan or this option may not be open to use in the future. The proposed current year goals and three year goals, therefore, are proposed at the level described in order to preserve the option of using federal programs should we need them in the future. y0 ya / City Council • October 18, 1977 Page 2 On October 14, 1977, the Housing Commission reviewed all of the information which follows and subsequently cast a unanimous vote to recommend that the City Council approve the amended Housing Assistance Plan goals. GOALS MIENDMENI'S FOR FY '78 HOUSING ASSISTANCE PLAN It is proposed that the Housing Assistance Plan for FY 178 include four different segments: New construction of rental units, rental assistance to existing rental units, rehabilitation of rental units, and rehabilitation of owner -occupied units. 1. New construction of rental units It is proposed that the City support an application for 81 units of Section 8 housing for the elderly that has been proposed by Midstates to be built on Urban Renewal land. HUD will provide conventional financing and mortgage insurance to Midstates to facilitate their development of new housing construction in Iowa City. The City of Iowa City will provide technical assistance and project packaging assistance as necessary to help Midstates develop a successful project. ' It is proposed that the City support the allocation of 100 units Section 202 funding awarded to the Ecumenical Housing Corporation. Section 202 is a direct loan by the Federal government to a non-profit corporation to allow construction of housing for the elderly. The City of Iowa City will provide technical assistance and project packaging assistance as necessary. There is also a chance that we would write down the cost of the housing site to further facilitate the development of this project. It is also proposed that the City support the Systems Unlimited Section 202 award of 48 units to develop scattered site housing for the handicapped. HUD will provide a direct loan to Systems Unlimited, a non-profit corporation, to construct housing for the handicapped. The City of Iowa City will provide technical assistance and project packaging assistance as necessary. It is also proposed that the City support new construction of 50 units of Section 8 housing for families, 40 units for small families and 10 units for large families. The needs statement suggests that new construction housing for low income families is desirable and the above has been proposed as part of the Winding Creek project. To summarize new construction of rental units, the following is proposed. A total of 229 units for the handicapped and elderly, 40 units for small families, and 10 units for large families. 2. Rent subsidy for existing rental units The goal for Iowa City for FY 178 is to convert 72 units of Section 23 housing, a discontinued HUD program, into the Section 8 program now designed to provide family housing assistance payments to low income families. City Council • October 18, 1977 Page 3 Rehabilitation of rental units It is proposed that the City encourage rehabilitation of existing housing units by providing technical and financial assistance to owners of eligible properties. The currently developed CDBG Housing Program only serves tenants when they are part of an owner -occupied duplex, therefore, it is proposed that financing be used to assist three handicapped and elderly families, 2 small families, and 1 large family who are renters. It is proposed that Section 312 funds be used in addition to provide financial assistance to 20 small families. (The Section 312 program provides direct loans to owners of residential property for rehabili- tation activities.) To summarize, 26 rental structures are to be rehabilitated during FY 178. Housing rehabilitation assistance to homeowners It is proposed that the Rehabilitation staff use CDBG funds to provide rehabili- tation assistance to 41 homeowners. This will include 8 elderly or handicapped and 33 small families. The housing goals for FY 178 would provide assistance to 418 households. This includes 280 handicapped or elderly, 117 small families, and 21 large famili.es. Three year goals for the Housing Assistance Plan include 5 different types of activity ies: New construction of rental units, rental assistance to existing units, rehabilitation of rental units, rehabilitation of owner -occupied units and new construction of owner -occupied units. 1. New rental units In addition to the one year goals of 279 units, the three year goal includes a proposed 90 units for small and large families. The staff wishes to provide 40 of these units through the Iowa Housing Finance Authority through their Section F allocations and through their innovative housing program now under consideration. The staff is currently studying the feasibility of developing a local housing program in order to provide the other 50 units over the next three years. 2. Rental assistance to existing units In addition to the FY '78 goals in which 72 units of Section 23 housing will be converted to the Section 8 programs, it is proposed that the City apply for 28 additional units. This program provides financial assistance to low income tenants. The Housing Commission has asked that an additional 50 units be proposed for married student housing, however, staff analysis shows that married student housing can be funded through several other programs more appropriate to their needs and City staff capability at this time. 0 0 City Council October 18, 1977 Page 4 3. Rehabilitation of rental units The 3 year goals,include a more active effort by the City to utilize both 312 loans and CDBG financing to assist landlords in bringing their structure up to minimum housing standards. The 3 year goal includes an additional 95 units (50 structures) to be rehabilitated as compared to the one year goal. 4. Rehabilitation of owner -occupied units During the next three years, it is proposed that an additional 59 units be rehabilitated using CDBG financing and 20 units using the 312 loan program. 5. New construction of owner -occupied units The Section 235 program provides mortgage insurance of up to $35,000 for four bedroom housing. This is at a 5% interest rate. HUD has encouraged Iowa City to actively try to use this program to meet Iowa City's housing needs. By in- cluding 12 units of Section 235 assistance in the three year goals, we can plan to develop a workshop and facilitate the development of new construction of owner -occupied structures. The total three year housing goal would provide assistance to a total of 722 lower income households in Iowa City. 388 of these households are elderly and handicapped, 290 are small families and 44 are large families. The fulfillment of these three year goals will satisfy approximately 30% of the existing need for lower income housing assistance. Staff plans to continue studying the nature of housing problems in Iowa City and the most appropriate alternatives for satisfying the housing needs of specific groups. Several studies are currently being developed to innovatively address the housing filtering process and, in addition, the Housing Commission has asked the staff to investigate mobile home courts as a possible alternative for low income housing in future years. 0 0 H O U S I N G A S S I S T A N C E P L A N Community Development Block Grant Application M B -77 -HN -19-0005 Amendment Date: November 8, 1977 Prepared by: Department of Community Development Dennis Kraft, Director Julie Vann, CDBG Program Coordinator Sue Sheets, Redevelopment Specialist r _ OMR A,r.w.l Na 29I -R0118 414-101 hw..I'd N GL4 r.Md rwi.wnA IX.wir FI -F FEDERAL ASSISTANCE L APPLE-UY • .. NUMBER B -77 -HN -19-000 i. n a WSIR 771339 "Krs APPLE 11. DAT[ w wA rwu A 710141AP►LICb IDENTIF RIG 1. TYPE ❑ /RU►/LICATION L DATE Y.., MU, A., 77 11 8 ACTION APPLICATION Amendment CATION 1S AT1I1N1D lr L.... IY..A.► ❑ NOTIFICATION OF INTENT (DPU C:r ' p WONT OF T ERILL ACTION w•• L LEGAL APPLICANT/"LCI/ICM L FEDIER" EMPLOYER IDENTIFICATION NO. 42-600-4805 .. AFdY.d N..N I City of Iowa City S. a4..11dir Y.N I a 1 4. F 1118 L iD.d//.O. M 1 410 E. Washington Street PRD. a NOwu L Tnl1 Community Develop - Iowa City a E...r I Johnson GRAY 4, CI I Iowa S.ZIP (rN 52240 ment Block Grants/ 1. ibr 1 Grants 11 C.dM PR.r IN.rC-9-60)Entitlement Neal Berlin -- (319)354-1800 Hold Harmless g •IOWA~ Nas I 1 T. TITLE AND DESCRIPTION Of APPLICANT" PROILCT S. TYPE OF APPLICANT/RECIPIENT LM.1. I..N.C. W `f71W Adl.c .1P�I Hd01, N.W.rU dke Third Year Community Development Block Grant r� i ;`.d/Pll Program `� t_°i,,.OW Dldrld r 61= P"Pw SPEW .s,•.P+t.(. Iwlw S. TYPE OF ASSISTANCE A-S.A grad D-Imm S-luxleawW Sr.d &4XW SPEW .,,rr 04AS V i.w 4uw(.J M AREA OF PROJECT IMPACT N.wr •I.DW,.w.16% 11.I.a dal 11. ESTIMATED NUM. SEA OF PERSONS IL TYPE OF APPLICATION A-Nw D ICOR.. E-19..61AIIN Iawe City N[N[FITIND 54~1 yCMlUww r.1w.►,.,.w.1.11..® 47 744 IL PROPOSED FUNDING 14. CONGRESSIONAL DISTRICTS Of. ILTPMI�G#"fy&) bw�lI .. FUERAL S 2,061,000 ,b a APPLICANT L PSDNer LDnww "Ina C HAP revised L APPLICANT •M Iowa-lst Dist. City - D-0.4480 E-4wINUa L STAnI .M 1L ►ROl[ti START 1T. PROJECT r.,.. .».► f DATIA A, DURATION P,(w. Y11wo) 1. LOCAL 77�-11t Y.wb .b ONES IL ES (MATEDSUNUIDATILT Yw w..lA A, IS. EXISTING FEDERAL IDENTIFICATION NUMBER a 'NN gO TO OO FEDERAL AGENCY So 19 77 11 8 B -76 -HN -19-0005 L TeT1l S , , .M 1L FEDLIULL A09MY TO RECEIVE REQUEST INAwA eNa E1514, ZIP "SP) 1 11. 011. N" --- Dept. of Housing 8 Urban Development, Omaha, Nebraska 68106 VIPs NP SL a To Y Sr r 1ST/ LA..Id/. w Ww, L = IV Sol `MICS h4 d y @P W all W, EMM Fes: NNo Rl= 6 sop W I.Y Y SW P...I11WI.11h1111.111� N616116 THE n. w w.d. Sd i.o..l W rm Agencies not fied 6-12-77 APPLICANT C.Y ..waw{ 1F Rr S...2W4 1M IN a State of Iowa -Office of Planning 6 Prog. CMIF10 tl+.IdWd w w .PPll.w will a,e* THAT 0- Ira '» armaw a.. N lu low- 4D East Central Ia. Ass'n of Regional Plan. El ❑ wr N .M.w. e) ❑ ❑ O. a TYPES WA AMC TALL L SIONIRME • SATE SIGNED rw w+tA Ar CIENTNITING REM Neal G. Berlin, City Manager 1S 77 11 8 SITITATIYE IL AGENCY WWII TION rMJCA• rw w.lA A, RECEIVED IS IN. ORGANIZATONLL UNIT ST. ADMINISTMTWE O/FIC[ NS. FEDERAL APPLICATION IDENTIFICATION 10. ADORE" Be L GRANT IDENTIFICATION SL ACTION TAKEN 21. FUNDING rw ....Y N IL rw wa1► A, STARTING a FFN4WL I AO a AWARDED NE. ACTION DATE IS DATE IS Q Q L KKCIO L AMNAST ,Ip EL CONTACT FOR ADDITIONAL IMFORYA TION IM.w .d ubPMr wIw) Ia rw ---U AN KPINO a tivi AO Q a NETUISI[I NIR DATE 1I L LODIL AO $F. REMARKS ADDED MUDIGN . OTNO AD (3 L IMPOSING • MITHSRAMR 1. MAI 11 AO ❑ Yw Na SL a I. WAS .ww Min, ..Y ,an.rr .N.I.w I" dvl. Iwr -.r..w. 4K b Fw M d nn 1, 1;11 Gn.ld A-114 ■d. N P. FEDIML MU1CC ASS OFFICIAL INS.,, *PA W.PI ~ w) FEDERAL AGENCY y mH,d.Wo N Iw 5... r M i.lypr PON 0".. "S ACTION M M,.. A,A ►ADP 1 (10.7111 414-101 hw..I'd N GL4 r.Md rwi.wnA IX.wir FI -F 0 0 FORWARD The City is now planning housing and community development programs which complement one another and work together to provide decent living environments for low and moderate income residents of Iowa City. This comprehensive approach is required by the Community Development Block Grant regulations. The Housing Assistance Plan, as attached, presents background data about the condition of housing in Iowa City and the number of lower income persons residing, or expecting to reside, in Iowa City. Thereafter, goals for utilizing federal assistance, to implement programs, to address the housing needs of low and moderate income residents, are presented. The programs provide assistance to both homeowners and renters: financial assistance for new construction of apartment complexes and/or single family dwellings, technical and financial assistance for the rehabilitation of existing apartment complexes and/or single family dwellings, and financial assistance to low income renters to subsidize rent payments. 0 0 TABLE OF CONTENTS I. Survey of Housing Conditions . . . . . . . . . . . . . . . . . . . . 2 II. Housing Assistance Needs of Lower Income Households . . . . . . . . 7 III. Goals for Lower Income Housing Assistance . . . . . . . . . . . . . 19 IV. General Location for Proposed Lower Income Housing. . . . . . . . . 24 1 Fr.. A,,.•.. OMS N. 67R.1171 HUD-70.SJ (It -EN • U.L DEPARTMENT OF HGUHNO AND URBAN DEVELOPMENT HOUSING ASSISTANCE PLAN - TABLE 1. SURVEY OF HOUSING CONDITIONS .A. HOUSING STATUS AND CONDITION OF ALL HOUSING UNITS IN THE MM 1. IMM. OF APPLICANT 3. APPLICATIONi GRANT NUMBER 1. LJI ORIOIM.L B - 7 7 - 1i N - 1 9 -10 0 0 5 I- .MEND.... City OF Iowa City, Iowa .. PROGRAM YEAR !..DATE 01 HOUSI.O SURR EY(51 USED FM.: July 1, 1977 10, July 30, 1978 NUMBER OF HOUSING UNITS LLL OMITS a"" BMTU YEAR STATUS AND CONDITION OF ALL HOUSING UNITS OF SUBTOTAL SUBTOTAL SUBTOTAL ESTIMATE TOTAL SUITABLE TOTAL SUITABLE TOTAL SUITABLE FOR FORFOR RENA RILITATION' REMABILITATION' REMABILITATNRI' co BI 6 m I.) In t 1 I 1.(k.*i./Will -Total 76-77 17,022 1,880 7,702 420 9,320 1,460 ' A. SJAIMalrd 76-77 1,952 1,880 1 462 420 1,490 1.46 ' L Stmldr4 w4 All O lUw (U.. 1 B:.o. 11.. 1.1 76-77 15,070 -0- 7,240 -0- 7 830 -0- • 2 VocMl A,.ilo►l. Unit, - Total 76-77 379 29 287 17 92 12 ' a Sohtond:d 76-77 32 29 17 17 15 12 • L SlmdMd r14 AI O16or (4., t ri... ti.; td 76-77 347 -0- 270 -0- 77 ' 3. Hwoioy Sm. kAvoilAls - Total I.. Ili... I mod 21 76-77 17,401 1,909 7 989 437 9.412 1,472 • 4. V.c.nq RH. 11/., t • 37 76-77 2.18% 1.51 3.601 3.891 98% .81% �U.NA ^SvO.U.MRd.MIinNd'.vuM nLhdxu.4.wJ IIh.MGconnL,npuq uAdIIH.R.nr.rwP. T.U. III, GwI. IN LwrIxr lWay bUAMxN E. DEFINITIONS, DATA SOURCES, AND METHODS (AHI.cl DddII,RRal pop..) (See attached Addendum A) L ORBdNo of "uMbRAd" Eo.L 2. DRB.INoo R1 "oMiHU. Mr TRAoSiIlbNoi' MARL 1 DMEB wnRR rd MRAodA .BML HUD-70.SJ (It -EN • City of Iowa City, Iowa Housing Assistance Plan Addendum A: Table I - Survey of Housing Conditions B. DEFINITIONS, DATA SOURCES AND METHODS 1. Definition of Substandard Housing Substandard structures are buildings that do not comply with major provisions of the Minimum Housing Standards (Section 9.30, Municipal Code of Iowa City) that directly relate to the health and safety of tenants. Overcrowded living conditions, structural hazards, infestation, lack of one or more plumbing facilities, and fire hazards are primary considerations in the designation of substandard structures. Such buildings are considered per H.A.P. definitions, as having dwelling units which do not provide adequate housing for occupants. 2. Definition of Suitable -for -Rehabilitation Suitable -for -Rehabilitation buildings are structures which have accumulated defects and deficiencies but not to the point of precluding their economic and physical feasibility of rehabilitation. Structures not suitable for rehabilitation include those having (1) excessive repair -to -value ratio, (2) incompatible land use relationship, (3) location in floodways, (4) location outside project planning area boundaries. 3. Data Sources and Methodology Data Sources U.S. Census of Population: 1970, Computer Summary Tapes, Johnson County, Iowa, Count 4, U.S. Government Printing Office; Washington, D.C. Survey of Exterior Building Conditions (1974), Department of Community Development. Rental Houing Survey, Department of Community Development, City of Iowa City, Iowas, 1975. Field Survey of Substandard Housing (1976, 1977). Department of Community Development Housing Division code and permit records (1976-77). Iowa City Plan: Report on Housing, Department of Community Development, City of Iowa City, Iowa, 1977. P 0 0 Addendum A: Table I - Survey of Housing Conditions Page 2 Methodology The available housing stock (line 3) in Iowa City was obtained from current demolition and construction records. Figures included in columns (b) and (c), "all units," were established through analysis of existing housing data and through updating that data with appropriate surveys. Limitations of available data precluded exact enumeration of figures in each column, consequently various projection rate factors were developed to complete 'owner" and "renter" categories. Specific rationale for each column is given below. Column (b): All Units Totals Line 3 Analysis of existing housing records (updating from City construction and demolition permit records) indicates that the current housing stock is 17,401 units. This count does not include rooming units, however, it does include 48 buildings which have rooming units. Among these are 9 university residence halls and 26 fraternity or sorority houses which provide rooms for approximately 6500 university students. Lines 4, 2 and 1 Analysis of 1974 Special Census data reveals a city-wide vacancy rate of 2.18% including houses for sale or rent (a decrease from 4.58% as reported in the 1970 Census). This figure when applied to total current housing stock results in 379 vacant units and 17,022 occupied units. Lines la and 2a; lb and 2b Substandard structures on these lines are a total of projected sub- standard structures from columns (d) and (f). Lines lb and 2b were computed as per table instructions. Column (c): All Units Suitable for Rehabilitation All lines are totals from specific categories in columns (e) and (g) which are detailed below. Column (d): Owner Occupied Totals Line 3 Estimates for the total number of owner housing units were computed according to 1970 Census data percentages. Owner housing is approximately 45.9% of all housing units in Iowa City, thus 7989 units are owner units. Housing records indicate that this ratio has not significantly changed in the past seven years. 4 0 0 Addendum A: Table I - Survey of Housing Conditions Page 3 Lines 4, 2 and 1 Frequent fluctuations in the Iowa City housing market provide a difficult situation for maintaining accurate records on housing vacancies. There- fore, given the overall city vacancy rate of 2.180 (1974 Census) and the rental vacancy rate of .98% (1975 Rental Housing Survey) the rate of 3.600 (as computed below) for owner occupied housing was estimated from residual figures. Specifically, .0218 times 17,401 equals 379 vacant units city wide. Of 9,412 rental units, approximately 92 are vacant. 379 - 92 = 287 owner units vacant and these units are approximately 3.60% of all owner units. Realtors and other persons knowledgeable about the Iowa City real estate market support the figure 3.60% as a realistic estimation of owner unit vacancy rate. Subtracting out the 287 vacant owner units (line 2) from 7,989 total owner units available (line 4) leaves 7,702 owner units which are occupied (line 1). Lines la and 2a Estimates of substandard structures were dependent upon various sources, primarily a field survey update of the 1974 Survey of Housing Conditions and information provided by ongoing housing code enforcement activities. Approximately a 50% sample was taken in both the January 1976 field up- date and the January 1977 update. A description of the weighted rating system used is included in exhibit B. The number of single family units in fair to poor condition categories was projected proportionately to include all owner units. Using Census data and field surveys, supported by housing code enforcement data, an estimation of 479 (462 occupied, 17 vacant) substandard owner units resulted. This figure will fluctuate in the future due to systematic code enforcement activities directed toward discovering and ameliorating adverse housing conditions. Lines lb and 2b Lines lb and 2b were computed as per table instructions. Column (e): Owner Occupied Units Suitable for Rehabilitation Lines 1 and 2 Rehabitable structures were determined from the same sources used for lines la and 2a in column (d) applying criteria set forth in the definition of suitable -for -rehabilitation. A ten percent sample in- dicates that approximately 91% of all occupied units and 94% of the vacant units are suitable for rehabilitation. This latter percentage may decrease as unfit units are discovered in housing code enforcement systematic inspections. Structures enumerated on lines lb and 2b, column (d), are exempt from rehabilitation by definition, i.e., there may be one or more code violations present among standard and marginal structures, however, these violations would be of a type such that the health and safety of occupants is not significantly affected. 0 Addendum A: Table I - Survey of Housing Conditions Page 4 Column (f): Renter Occupied Totals Line 3 Estimates for the total number of renter according to 1970 census data percentages approximately 54.1% of all housing units are renter units. Lines 4, 2 and 1 0 housing units were computed Renter housing constitutes in Iowa City, thus 9,412 units A 1975 Community Development Survey of Rental Housing provided a .98% vacancy rate (line 2) for rental housing in Iowa City. This 50% sample of the rental units in Iowa City provided specific information on number of units vacant and amount of time they were vacant which allowed calculation of an annual unit -month vacancy rate (units vacant multiplied by the number of months vacant as a percentage of all unit -months in which housing could be occupied). This .98% vacancy rate was then applied to the number of rental units available (line 3) in order to compute vacant units (line 2) and occupied units (line 1) for all rental housing. Lines la and 2a The same sources and criteria used to estimate lines la and 2a in column (d) were used to estimate substandard structures in column (f) lines la and 2a. Because of the code enforcement program activities during the past year, more is known about rental housing than owner housing, therefore, in computing substandard rental units, more reliance was placed on information available from the housing code enforcement division than other sources. Criteria set forth in the definition of substandard were employed in estimating both renter and owner substandard units. The rental vacancy rate was applied to total substandard rental units to compute the proportionate occupied sub- standard units (line la) and vacant substandard units (line 2a). Lines lb and 2b Lines lb and 2b were computed as per table instructions. Column (g): Renter Occupied Suitable for Rehabilitation Lines I and 2 Rehabitable structures were determined by application of criteria set forth in the definition of suitable -for -rehabilitation. A ten percent sample of substandard rental housing revealed that approximately 97% of occupied substandard rental units and 80% of vacant substandard rental units were suitable for rehabilitation. Structures enumerated on lines lb and 2b column (f) are exempt from rehabilitation by definition. 0 0 L w nr.n�al a wr\.\..r wr.. onHwYa] ASSISTANCE NEEDS OF LOWER INCOME HOUSEHOLDS HOUSING ASSISTANCE PLAN - TABLE II. HOUSING e a•I mo. ]. •rn¢.n{./. 1. YIow.L 11-S-77 (]..away wnl ' 1 ar ✓rLH..I 9- 7 7- H N' 1 9- 0 0 0 5Y...o+ Ju 17 1, 1977 he{ 30, 19713 • City of Iw{ City, Ia\ rpvoL o\H 10.14x calwn 01 InnCLltrxWHxom•...Irpnull rL'.Q�.„L�.l J L O..x,Kll{x.w.fIn.Il\L IS L.IL.QY.IYi \.Q x\ .Q..I..\nl[ .. e iItwI[LL .ICY,,,wlnu,Y 01 \....w....L.. •....I Q.......1awu Q..Ln.... ...... xH{um WLIMWOw ..LJ {'r"L', .wlcuecL �•a ..euL.w ..rL. LlOh,w ,usL .LnxL.w I._L. �. .g411.Y mwL I._.. IIwY.'I I n IIw,�J .O L.I Y,YLLM 11•]Pnwl ILMI-. (E M. .l p1_M rom ueL.rn 1\M 4,. lir • �I-0Ir..rr/ Im I 11.]Iw,...l rw.rl pru,J I 1 •11 I •11 1 1,•11 1,•fl 1.11 Irll II•II 11.41 Il�fl 11'I •II Irl 9 1 I I 1 9 ]ttEA M03E110L0310 I J. .1•DW S SI T tE{TOIMOOSIGLD3 11 0 30 1 41 .dd. A. ..TMJ MOWEIOLOS EXPECTED TO IN DISPLACED w MMH 7E9R41.r.l L.rr 1-11 9z{ Romm" 1 i9 E 93 TOIJL II.. .LISP, AA.JI'! 31 L 0 0 City of Iowa City !lousing Assistance Plan Addendum A: Table II - Housing Assistance Needs of Lower Income Households F. DATA SOURCES AND METHODS Data Sources Housing Unit Occupancy Characteristics, 1970 Housing Census, prepared by HUD -ENO (CO), April 1974. 1970 Census of Po ulation Volume 1 - Characteristics of the Po ulation, Part 17 - Iowa, U.S. Department o Commerce, Bureau o t e Census, issued February 1973. Volume 1- Housing Characteristics for States sued August 1972. Planning and Housing Divisions, Department of Community Development, City of Iowa City, Iowa. Rental Housing Survey - 1975, Department of Community Development, City of Iowa City, Iowa. Johnson County Employer Survey - 1975, Johnson County Regional Planning Commission, Iowa City, Iowa. Methodology The two sources heavily relied upon to provide estimates of households in need were the HUD table, Housing Unit Occupancy Characteristics, prepared for Johnson County and Characteristics of the Population prepared for cities, counties and the state by the Bureau of the Census. Although both sources were compiled from data gathered in the 1970 Census of the Population, they presented differing information about the county population, specifically the number of households residing within the county. Nevertheless, there were advantages to using both sources in compiling estimates of lower income households for Iowa City. The HUD table, which cross tabulated households by age, income and tenancy, was used to derive percentages for columns (b-2) through (b-4). These percentages were then applied to Iowa City population data obtained from various tables in Characteristics of the Population by the Bureau of the Census. Calculations performed for specific columns are outlined below. In all cases, 50% of median income was used as an indicator of lower income for families and 125% of poverty level was used as an indicator of lower income for primary individuals. (50% of median income for primary individuals falls $350 below poverty level in Iowa City.) 0 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 2 Column (b-1): Total Households Requiring Assistance All lines All figures in this column are sums of appropriate lines under columns (b-2) through (b-4). Column (b-2): Elderly or Handicapped Households Lines 1 an 2 Owner households are the largest group of low income households requiring assistance. This is directly related to the large number of elderly home- owners requiring assistance which in turn may be attributed to the fact that many of the elderly in Iowa City reside in older homes which they have not been able to modernize or maintain with their limited fixed incomes. Their low income may also prohibit them from being able to pay rent for adequate housing should they choose to give up their homes. 1970 Population Census Tables 29 and 30 show that Iowa City has 942 elderly families (age 65+) and 1030 elderly primary individual households. To deter- mine the number of lower income households among the Iowa City elderly population, a percentage rate was developed from county -wide statistics. Using data from the HUD table, "Housing Unit Occupancy Characteristics," the following calculations were made: Johnson County Data - Caloulationa for ElderZy Tenure 1 person elderly households=1552 (915 owner, 637 renter) 2 person elderly households=1978 (1675 owner, 303 renter) 1 person low intone elderly households=883 (551 owner, 332 renter) 2 person low income elderly households -742 (591 owner, 151 renter) (Two-thirds of the county population resides within the boundaries of Iowa City). Using data from the HUD Table, Housing Unit Occupancy Characteristics, the following calculations were made. Of all 1 person elderly households 59% are owners and 41% are renters. Among the owners (551/915) 60% are low income owners; and (332/637) 52% are low income renters. Of all 2 person elderly households 85% are owners and 15% are renters. Among the owners 35% are low income owners, and among the renters 50% are low income. 10 11 F_I Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 3 Applying these percentages to the Iowa City elderly population, the following numbers are derived: Iowa City Data - Calculations for EZderly Tenure 1 person elderly households=1030 x 59% = 607 owners x 41% = 423 renters 2 person elderly households= 942 x 85% = 801 owners x 15% = 141 renters Iowa City Data - Calculation for Elderly Low Income 1 person elderly owner households=607 x 60% = 364 low income 2 person elderly owner households=801 x 35% = 281 low income 1 person elderly renter households=423 x 52% = 220 low income 2 person elderly renter households=141 x 50% = 71 low income 936 lower income elderly households Elderly households below lower income levels in Iowa City are estimated at 64S owner households and 291 renter households. It is clear that a much larger percentage of 2 person elderly households than 1 person elderly households own their own homes. One very likely explanation for this phenomenon is that one spouse is unwilling or unable to maintain a home after the other spouse has died. If this is the case, then we can in 1977 expect a much higher number of elderly persons needing rental assistance than the estimate made from 1970 data. It is also clear from the HUD Table of Housing Unit Occupancy Characteristics, that approximately 19% more elderly renter households are living in substandard housing or paying more than 25% of their income for rent even though they do not fall below the lower income limits. The student population in Iowa City is largely responsible for the high demand for rental housing, thus market rental schedules are inflated. The estimate of 291 renter households below income levels is, by itself, a distorted estimate of total elderly households requiring assistance, there- fore, an additional 19% (those above income levels but living in substandard housing) was added to the renter category. Thus, 107 plus 291 equals 398 elderly renter households requiring assistance, along with 645 owner house- holds requiring assistance. 11 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 4 Estimation of the number of handicapped households requiring assistance was based upon percentage rates derived from Table 52, Characteristics of the Population, 1970 Census and City Planning reports. According to the tagle,-2.-S-V oY the population age 16-64 has a work disability of over 6 months duration. Iowa City, however, has a higher percentage of handicapped and disabled persons (10.2%) partially due to the availability of services for the handicapped in the area. Of 33,688 people in Iowa City age 16-64, 3,436 are disabled or handicapped and 21% of the handicapped are lower income people (721 lower income handicapped) according to Table 169 of the census data. An additional 30% of the low income handicapped are living in families of more than two people (Table 169), thus they cannot be counted in column (b-2). 721 lower intone handicapped minus 30% (216), leaves 505 handicapped persons requiring assistance. Assuming one handicapped person per household, the estimate of 505 can be translated to 505 handicapped households requiring assistance. Since housing data is not available for handicapped persons, the city average of 54% owner -occupied was applied to the handicapped group. Owner Renter Elderly requiring assistance 645 398 Handicapped requiring assistance 272 233 917 631 Households assisted 3 241 Total in need 914 390 Currently, 3 owner households are being assisted through the Housing Rehabilitation program and 202 elderly and handicapped households are receiving assistance from Section 8 and Section 23 housing assistance programs in Iowa City. An additional 39 elderly and handicapped receive a housing subsidy from the 236 project, bringing the total households assisted to 244. Households below income levels minus households currently assisted leaves 390 renter households in need of assistance and 914 owner households in need of assistance. Column (b-3): Family Households (4 or less persons) Lines 1 and 2 Again, county -wide percentages were developed from the HUD Table, Household Unit Occupancy Characteristics. 12 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 5 Sixty-five percent of all non -elderly households in the county are families of 2-4 people, and 16% are primary individuals. The category of family of four persons or less is a combination of small families and primary individuals as enumerated by the census. Among small families, 23% are lower income families and 44% of the non -elderly primary individuals are lower income. IOW City Non -elderly households=76941 Non -elderly small families=76941 x 65%2 = 5001 Low income small families=5001 x 23%2 = 1150 Non -elderly primary individuals=76941 x 16%2 = 1231 Low income primary individuals=1231 x 44%2 = 542 Among these low income persons 17% oft families own their homes and 11% of primary individuals own their homes: Low income small families -1150 x 17%2 = 196 owner households Low income primary individuals=542 x 11%2 = 60 owner households Low income small families renting=1150 - 196 • 954 renter households Low income primary individuals renting -542 - 60 = 482 renter households Currently, 2 owner families receive assistance through the Housing Rehabili- tation program, 84 families of low income are receiving rental assistance from Section 8 and Section 23 housing programs, approximately 147 small families receive a rent subsidy through a 236 housing program, and 729 small families of lower income receive subsidies through the university married student housing program. Subtracting from 1436, this leaves 476 renter families and 254 owner families needing housing assistance. Column (b-4): Large Families (5 or more people) Lines 1 and 2 Large families comprise 23% of the county family households. Of large families, only 6.7% are low income households. 1Characteristics of the Population, Table 29, 1970 Census. 2Housing Unit Occupancy Characteristics, prepared by HUD from 1970 Census. f IKi 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 6 Iowa City Non -elderly households -7694 x 23% - 1770 large families Low Income large families=1770 x 6.7% = 119 families Eleven percent of the 119 families are homeowners (13) and 106 are renters. Section 8 and 23 housing programs provide rental assistance to 11 large families while 62 large families receive subsidies from the 236 housing project, leaving 33 large families in need of housing assistance. Column (c-1): Total Female -Headed Househo Figures in this column are sums of appropriate lines under columns (c-2) through (c-4). Column (c-2): Elderly or Handicapped Female -Headed Households To calculate the number of elderly households in need that are headed by a female, percentages were developed using Table 30 of Characteristics of the Population, 1970 Census. Table 30 reveals that 17% of all elderly family heads are female and 85% of all elderly primary individuals are female. Thus: 1 person low income elderly owners, 364 x 85% = 309 1 person low income elderly renters, 220 x 85% = 187 2 person low income elderly owners, 281 x 17% = 48 2 person low income elderly renters, 71 x 17% = 11 Total 555 female -headed elderly low income households Three of the one person owner households are currently assisted through the Housing Rehabilitation Program, 100 are assisted through Section 8 and Section 23 Housing Assistance, and about 30 are receiving subsidies from the 236 project, leaving 68 elderly low income female -headed households in need of assistance. The data necessary to determine the number of non -elderly female -headed handicapped households is not available. Column (c-3): Female -headed Family Households Table 29 of Characteristics of the Poulation, 1970 Census, shows that 569 or 7% of all non -elderly family e s are emales and 2009 or 49% of all primary individuals are females. Applying these percentages to previous estimations of lower income households in this category, the following estimates are derived: 14 0 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 7 Non -elderly lower income families, owner, 196 x 7% = 14 Non -elderly lower income families, renter, 954 x 7% = 64 Non -elderly low income primary individuals, owner, 60 x 49% = 29 Non -elderly low income primary individuals, renter, 482 x 499 = 236 343 female -headed families Section 8 and Section 23 housing assistance programs offer rental assistance to 55 female -headed lower income families, approximately 200 aye assisted by the University and 45 are assisted through the 236 project, leaving 43 female -headed owner households and 100 female -headed renter households needing assistance. Column (c-4): Female -headed Large Families Again Table 29 of Characteristicsof the Po ulation provided the data necessary to calculate female- eaded ouseholds. Among Iowa City non -elderly families, only 7% are headed by a female, therefore: Large family lower income owners, 13 x 7% = 1 Large family lower income renters, 106 x 7% = 7 8 female -headed large family households Eight female -headed lower income large families are receiving assistance through the Section 23 housing assistance program, however, it is likely that there are female -headed households among the large families yet to be assisted. Numbers entered on lines 1 and 2 in column (c-4) are 7% of lines 1 and 2, column (b-4). Columns (d-1) through (d-4): All Minority Households Figures in these columns are sums of appropriate lines under columns (e-1) through (f-4), minus the number of households currently assisted. Columns (e-1) through (e-5): Black Households Unfortunately, the HUD Table, Housin Unit Occupancy Characteristics, did not enumerate minority households. Luise, Iowa City's minority population is comparatively so small that Census data lists very little information about this group. Table III of Characteristics of thePo ulation, shows 14 black families and 55 black primary n iv uals all ng elow t e lower income limits. Table 30, of the same source shows that 7.5% of all black families are elderly and 3% of black primary individuals are elderly, therefore, 7.5% of 14 families and 3% of 55 primary individuals equals 4 15 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Page 8 black elderly families of lower income. Of the remaining lower income black families (12), 2 are large families (column (e-5)), leaving 10 black small families plus 53 primary individuals or a total of 63 in the family category (column (e-4)). Current assistance is given to 3 black elderly families through Section 8 housing assistance and the 236 housing project, and assistance is given to 35 families, leaving 1 elderly black family, 28 black families and 2 black large families needing assistance. (Renter/owner categories were based upon Table 56 of Housing Characteristics for States, Counties and Cities which revealed that 16 of blacks own their homes. Column (f-1) through (f-4): Other Minorities Information about "other minorities" in Iowa City is even more scarce than information about black families. The total number of minority families and primary individuals was derived by subtracting blacks and whites from total households. The difference was assumed to be "other minorities." In any case, these people should be accounted for in the housing assistance estimates. Since there are no housing, income or age breakdowns listed in any Census data source for this group, percentages derived from information on black households was applied to this group. For instance, 44% of black households are lower income, 7.5% of these are black elderly families, 3% are black elderly primary individuals, 19% are black large families and 70.5$ are non -elderly families and primary individuals. These percentages were applied to the total number of "other minority" households to obtain figures for each column (9 elderly, 58 family, 15 large family). Current programs are assisting 3 elderly households, 15 family households, and 11 large family households in rental housing. These figures are subtracted to reveal the figures in appropriate columns. Columns (b-1) and (b-2): Households Expected to be Displaced Line 3 During the next year of Block Grant activities, one elderly homeowner will be displaced as a result of the Ralston Creek Improvements Project. No other displacements are planned nor foreseen. Column (b-1): Total Additional Families Expected to Reside Line 6 Per HAP instructions, any community in a non -metropolitan area must submit its best estimate of the number of non-resident families with workers employed in the community, who could reasonably be expected to reside there. The following calculations are based upon information from the Johnson County Employer's Survey - 1975, prepared by the Johnson County Regional Planning Commission. 16 11 A: Table II - Housing Assistance Needs of Lower 0 Number of people working in Iowa City or Coralville, and living in small towns in Johnson County 3271 Number of people working in Iowa City or Coralville, and living in rural Johnson County 1153 Number of people working in Iowa City or Coralville, and living outside Johnson County 1144 Total number working in area, but living outside Iowa City or Coralville 5568 In 1970, 38% of all families in the county had incomes below 80% of median income. (Source: Johnson County Regional Planning Commission) Assuming that this percentage can be applied to all persons working in Iowa City and Coralville, then 5568 x 38% yields 2116 persons of low income working in Iowa City or Coralville and residing elsewhere. It is further assumed that (a) only the low income workers living outside the count would benefit by moving closer to their work and (b) if they moved, they would locate inside the boundaries of Iowa City, rather than elsewhere in the county. Commuters to Iowa City from outside the county comprise 20.5% of all commters (1144/5568), therefore: low income commuters, 2116 x 20.5% = 434 expected to reside in Iowa City if housing were available Conceivably, a large portion of those expected to reside in Iowa City will be elderly. The next year will bring no appreciable influx of non -elderly lower income households over last year for two significant reasons: (a) the lack of new employemnt, and (b) the lack of low cost housing alternatives. For the most part, new employment is either part-time work or is absorbed by unemployed residents within the community. Although University employment has been growing steadily, there have been and will be no significant increases in jobs which would attract lower income households. The large number of University students in Iowa City places heavy demands on the rental housing market. Rental rates and housing costs are higher within the community than anywhere in the county or surrounding counties, hence, it is unlikely that lower income families will have incentive to move into the community from surrounding areas. (According to the local 17 0 0 Addendum A: Table II - Housing Assistance Needs of Lower Income Households Fa -el 0 Board of Realtors, the average house sale in 1976 was $41,610. Likewise, rents have increased to a level where the average rent for a one -bedroom apartment is $155/month.) The increase in the need for housing assistance will most probably occur along established patterns, i.e., elderly families will become unwilling or financially and physically unable to maintain their previous homes. Elderly families within the county move to Iowa City to be closer to medical, recreational, and social services, a major concern for older citizens. For those elderly already residing in the community, moving from a large empty home to a smaller apartment allows them to maintain a modest, but independent lifestyle as long as possible. 18 0 0 Iw. yXnN OX\X.\I\.YII Xr••1.11 •.xr oI, DII•.IrrNr OI aw, w', •.0 0.1•. DI VL.01Y1+1 ...10"..C1 Nur TAILS M. GOALS IDE LOWER INCOME MOUSING ASSISTANCE CURRSMT TSAR COAL .w o......L..r r a...r... city of low$ city p[• ..uo.•+r. e.rl, 11.2-77 ...... I• 4 ' .......... 7•1-77 ro 0.30-78 I7LITr'IN IN '�1 9 'I0 0 0 5 w$1. or .onl.o,m rDn wnno _ rrrn..o nwLNor nvn•.11 .u.e.m �•'D•c.•nn :i.'e. � ••"" YI U1 � 41 , 10 bl J. XI. MA1 Y.Il1 I I ! 41 ._{ _10 _10 1 _SNrr.hr•u=i\IN v_.Ll—._..—d i_. _ _.. ...._.D_ 7 0— . _..._ o • 3. Orb,,ArmW Nr+ R Nr..ry 81143 stlloa 2PZ• 3mD —__— _.?ie '}ie —i_—p .' 229• ,- —4D-" r— 1 �I. NM.II11111r0. 01111YrLL UX111 •- 3. S;-T:y J.T�xl ff.•.l ln. W 1, �.� L OrLw Mu+N R14L:IIINN. •1 RNrN ,..1 Rlr..hl. LIQ 22 3 _J _ 1 2e .. • 1DID31 _W , D o 30-7- _ DIO 7 7 _ 22I C RLIIINL WRNILL Y.ITS 1 i— .Ir.....J Ir . LcIwI L •Orr Lar A.,I,x1 eN.r,N R.n�N.:,ry I lu.w I -TNI • . 1, 1N//Sr. bu IJ,IJ I/ I. IIXgRILpON ASSIM-n fO.OMID.+UI OR I.OMI 11., NDn10.X ILl Y aIIN/C.NY 41 a 32 a Nlooiit In n L Oro RrLiRmw. MriN.rf.1. N�N....w N & 70 1A+. L.rr I,), rll 41 ISD L .I.CO.ITEYC110+YNw$STANCITDYO.IoSR,o% .•evlCTM M I!OwN R n 1. NrW N I. ALL IOOYNL Y411A.CI MASSIT.. NL.. 11•A.M.IN,.JU/ LIE 290 117 21 19 0 0 I... 3.11.._. 20 wL ptr•nan pr .=. ::o v.••. o[rN a.aYl NWMrp •I VII•.<I IIM TARLI III. GOALS FOR LORI INCON I MOUSING ASSISTANCE THREE FEAR COAL ..n o.....m ... ...city oT to+a city �,......... E..� 11.3.77... 6•1D•7e 7171NIM-11v D 0 D 51•]1 •p•u • or Nopu Np.ol m a .unuG aril •+p ww[I[pr .lvlb•cl • I...ec qi� I[«1.. • •G' ouu.p. o. p_p1... r^..•I n.. G.NI L1 IN 1 10 111 LI .. YIY a1+LL 0.111 jJIMly1 I If.0 In.r ..N 11 c S.n.• t 2A A 7A L 641 1 pAwr A.�b1d M.. R-1.1 N..un 191 Ira 40 to • Rctim.201 - mm ag Ida 1nLR11ere1991Di.-9roA SD o —69—� ID • r. l.ul O..rb.n l.:...rL 0 120 20 a1 MUMIT .11p+01 NI+I•L UNITS I • 11. S.0 .LNyQ _ _�. __ZS_� Jr •�1 0 1 .. Sr.�N Ael..n•1Nr1!•. �I b..__. Ste_ _._ �_ ____O_. O StflLle� . � I i N..Yb1-1.1N 96 ie 66 ••I MUD 311 1 6 10 SD t •caln...... _�5 — • I L. l.N n.ull... IC. InfL+G 11.T.L UNITS r 1. Lnr 1.rUD' 0 39 • 1 f.N. -1.1.1!3... N.... r1 U I 1 1 01A. Anb1.r 1d4ny R -W M.u1.F n I•TNN •I S A. LA now fU..r l.3..4 31 1 Go sl D. RIN.OIGILTIOM.IIIIlANC110 NDY1p.+CRIOR IROIILCIIYt MpY10•N3Rt •. cO 51.1t6w1. 37 It $..N.• M 1 dM R.4330+L. ANinwN N, N...... N n res"..... Il3..Uh 1. 1.-w. N \ -L-TN /n•.. I 6n 1.1..r 11 M 110 M rS R 1..R. CYIO..mv. AINIIA.Cc To.0.30..IO OR .. 1.lwlrm 7 0 ID 7 •. aG. M...IN . TNJ .. \ TNN O.• .I W..1 wa 1) 11 0 10 1 .IF. ALL NOUN.G MUSUNC3 MALS 0-1Ern ...ILU.b .r U 396 n•I14R.T Or ALL HomwoLRt IOe\ Sr R RDs ee G. tvlAYAf lOalraq R1T1R 11r•.d ✓4i+.1p1^I 20 0 0 ADDENDUM A: TABLE III -- Goals for Lower Income Housing Assistance C. EXPLANATION OF PRIORITIES (a) New Rental Units Current year goals reflect projects expected to get underway during FY 178. Line 1, Section 8, New Rental Units, shows 131 units which are planned for construction in Iowa City. Of these, 81 units are proposed as housing for the elderly to be built in conjunction with Iowa City's Urban Renewal project. 40 units for families and 10 units for large families are part of the proposed Winding Creeks housing project. Under Other Assisted New Rental Housing, Line 6, Systems Unlimited, Inc. of Iowa City has proposed 48 units of scattered site housing for the handicapped to be financed by the HUD Section 202 program. In addition, the Ecumenical Housing Corporation, a consortium of local churches organized to build and manage housing in Iowa City, has been awarded 100 units of Section 202 elderly housing. It is clear from the needs statement that housing for the elderly and the handicapped is Iowa City's most pressing problem. (See (f) All Goals) The three year goals include goals for the current year and an additional 90 units of new rental housing for families. Iowa City is currently studying the feasibility of developing a local housing assistance program to provide 50 of these units. It is anticipated that the other 40 units will be pro- vided through the Iowa Housing Finance Authority (state agency), both through their Section 8 allocations and through their innovative housing program now being considered. Because of the current lack of adequate housing for low income families it is hoped that this new construction will provide space for these families and subsequently, will vacate smaller units for more appropriate uses. (b) Rehabilitation of Rental Units The quality of much of the existing housing stock in Iowa City is not sufficient to provide all present and expected City residents with safe, decent, and affordable housing. It has been very difficult as yet to per- suade local investors to undertake Section 8 rehabilitation when they can make higher profits by demolishing older buildings to build new apartment complexes. Therefore, current year goals do not include the Section 8 substantial rehabilitation program. Assistance will be provided in the current year goals to owners of rental units through the 312 loan program. Staff anticipates assisting 20 families through this program if the HUD regional office approves Iowa City's application as submitted. The City's CDBG loan program for rehabilitation is focused on owner -occupied structures, however, six rental structures will be rehabilitated during the next year due to their location within duplex owner -occupied structures. This will provide assistance to 3 elderly households, 2 families and 1 large family. 21 0 0 ae three year goals include the current year goal plus 85 units (one apart- nt complex, 25 units; and 25 structures, 60 units) planned for rehabilitation in the following two years. 25 of these units are anticipated for the Section 8 substantial rehabilitation program. The systematic code enforcement program in Iowa City has documented the need for assistance to some landlords in rehabilitating older multi -family dwelling units. This can be provided through the Section 8 program, and the staff will try to stimulate the use of this tool for improving the housing quality in an older apartment complex. In addition, staff estimates that 25 structures can be rehabilitated through existing 312 and CDBG loan programs. (c) Existing Rental Units The 72 new units of existing rental assistance shown on the current year goal are units that are being converted from Section 23 to the Section 8 program during FY 178. This phase out schedule was approved by HUD due to the difficulty in finding units for which contract rent did not exceed HUD specified fair market rents. The conversion of Section 23 units brings the current Section 8 rental assistance allocation to 309 contracts. The three year goals include current conversions and 28 additional contracts that Iowa City proposes to seek during the next three years. Despite problems with finding eligible units (those which meet HUD fair market rents), the scattered site program has been a popular one in Iowa City. The 28 units reflect staff estimations of a reasonable goal in light of the problems of obtaining units. (d) Rental Assistance to Homeowners The CDBG Housing Rehabilitation program implemented last year is now fully operational. The current level of staffing will allow rehabilitation for 41 units during FY 178 through CD Block Grant funding. The three year goal is based upon current staffing levels which are not expected to increase. The goals include the current year goal with additions of 59 rehabilitation projects through the CD Block Grant program and 20 units expected to be rehabilitated through the 312 loan program. (e) New Construction Assistance to Homeowners The Section 235 program has not been sufficently attractive to Iowa City developers and lenders as it is currently written, therefore, no units are expected during FY 178. Maximum construction price established for the 235 program appears to be too low for this area, however, the Iowa City housing staff has been working to generate renewed interest in the program. Three year�oals reflect reasonable staff expectations of 12 new 235 assistod—fomes within the next three years. (f) All Housing Assistance Goals In preparing the FY 178 HAP, goals were carefully chosen to match the needs statement, citizen priorities and specific housing problems. A major part of the goals for elderly and handicapped housing are being met by new construction projects. In the discussion of the methodology for calculating the needs 22 0 0 statement, it is clear that a large percentage (70%) of the low income elderly are homeowners. As elderly citizens become older they also become less capable of physically and financially maintaining a single family home. Realizing this fact, local groups have for many years strongly supported the new construction of elderly housing in Iowa City in order to provide the elderly housing population with a planned living environment appropriate to their social and financial needs. Likewise, citizen groups have strongly supported construction of new housing for the handicapped (non -elderly). Systems Unlimited, Inc., a non-profit corporation, has been influencial in promoting adequate housing for handicapped persons of all ages in Iowa City. Small and large family housing needs are different than those of the elderly population. While there is some need among these groups for rental housing, the major portion of the need can best be satisfied by providing adequate single family housing. Rental housing in many cases is not large enough to accommodate families. In view of this, a large part of the goals for small and large families are being addressed by housing rehabilitation programs and where assistance is not available for new construction of single family housing, assistance for new rental housing is being pursued. In addition, it is anticipated that the larger single-family housing released by the provision of new housing for the elderly, will fulfill some of the housing needs for small and large families. 23 U.S ARTMENT OF HOUSING AND URBAN DEVELOP HOUSING ASSISTANCE PLAN TABLE IV - GENERAL LOCATIONS FOR PROPOSED LOWER INCOME HOUSING 1. NAML OF APPLICANT 1. IX i ORIGINAL City of Iowa City, Iowa i.J AMENOM IN T, OATl1 2. APPLICATION/GRANT NUMBER A. PROGRAM YEAR FRGM:July 1, 1977To: June 30, 1978 B - 1 7 7- I H N- 1 9- 1 0 1 0 1 0 1 5 A. IDENTIFY GENERAL LOCATIONS ON MAP IN THIS APPLICATION I. New Construction: Census Tract Numbers 23, 24, 25, 35, 36, 37, 50, 52, 53, 57, 58, 59, and 60. 2. Rehabilitation: Census Tlact Numbers 23, 24, 25, 27, 28, 36, 37, 39, 40, 42, 43, 44, 45, 46, 47, 51, 52, 53, 54, SSI 57, 58, and 59. S. EXPLANATION OF SELECTION OF GENERAL LOCATIONS L -New Canstruction The areas chosen for both new and rehabilitated assisted housing will help to facilitate neighborhood restoration and rehabilitation. The City is anticipating a comprehensive neighborhood improvement program for much of the area shown is suitable for assisted housing. (See Neighborhood Improve- ment Map (attached)). The other areas outside the neighborhood improvement areas are newer neighborhoods which will benefit from a mix of population groups, income levels and housing types. The areas chosen for both new and rehabilitated housing will increase the housing choice of low income persons by offering increased despersion and an increased supply of low income housing. A mix of areas suited to rehabilitation and new construction are included so as to provide adequate choice for the location of assisted units. Most importantly the areas shown as suitable for assisted L Rehabilitation housing have good access to community facilities and services. Transit, shopping, parks and recreation, schools, and employment are all conveniently located to housing sites with these areas. 24 GENERAL LOCATIONS FOR PROPOSED SECTION 8 HOUSING APPROXIMATE SCALE IOWA CITY �o ENUMERATION DISTRICT 0 .62 mi. O 1970 IN 1 @a UMrv[RDfTY M[NMITe ©Q • ACCEPTABLE FOR NEW HOUSING - ©I ACCEPTABLE FOR REHABILITATED HOUSING -0 C©7 n ' Q• • u p (Bb • 01 0 October 31, 1977 TO: Mr. Neal G. Berlin, City Manager FROM: John Robinson, Member Board of Electrical Examiners and Appeals(, �� RE: Appeal by ACT, your memo dated October 26, 1977 I appreciate your view as City Manager toward desirable commercial development in Iowa City; however, I take exception to the patronizing tone of your memo and the implication that the board may be enforcing obsolete code requirements and is not open to suggestions. Principles of heat transfer, electrical power, and other laws of physics do not change with time nor respond to pressures of the market place. I can assure you that the members of the board are current in the technology, are not isolated from the outside world, and are always willing to listen to suggestions; however, safety to theup blic is our primary concern. cc: Board of Electrical Examiners and Appeals City Council ✓ yay/ 9 CITU OF CIVIC CENTER 410 E WASHINGTON ST November 4, 1977 Bivouac 32 S. Clinton Iowa City, Iowa 52240 Dear Sirs: 0 OWA CITY IOVdA GTY r., , •, c �, :c - The City desires to put up transit information signs which will have a map of the transit system routes and a time schedule. We would like to install this on the northeast corner of Clinton and Washington. The most desirable location would appear to be on the brick wall just to the east of your logo on the Washington Street side. The transit information sign is a wood framed sign approximately two feet by three feet which would fit against your wall and would protrude out from the wall two to three inches. Would you please give us your preliminary thoughts on whether it would be acceptable to attach this to your building. k'"Plastino of Public Works RJP/ j P cc: Hugh Mose City Manager City Council yay2 • • October 29, 1977 Mr. Rick Neshwil.er Senior Planner Dept. of Co munity Development Davis Building Iowa City, I,' 5PAIO ''year Mr. Oeshwiler: On October 25, at my renuest, tare, Iowa City City Council held R nublic he,!,ing on proposed Frrewny 518. At th t meeting, I made the charge that the city planning staff, in the prereration of the lnwa City Comnrehenni.ve Plan, wns negoti•iting wi.th r:',ie Iown DOT for nossible corridor loentions and design snecifications for a wester- ly bypass of the city. Preceeding my remarks, Mayor Neuhausee exnressed concerns that my Letter to t� a Editor in the Octo,rcr 21 issue of the Press Citizen incorrectly st-ted th t the staff was eng+grinr,. .in ally inrronriety In the prcl�crntion of the Comprehensive Plan. After my remarks, both the mayor anit City Msnar.er Berlin vigorously objected to my chnrres, stating emphatically that such was not the case. I iden- tified you ,s the staffnerson resnonsible for making the atledRed stntements upon which I bns6d my chnr�-es. tser,•,use •:f the strenuousness oC tl�c exec -tion to which my ctate- meets were recieved I attempted to mentally reconstruct the conver- sation which we had in early September. I found that I could not clearly recall what was snid, so I mad arrangements to taut to ,you the next day. As you know, after we discussed the matter for � while I stited th-t I hnd substanti•11 doubts about the reliability of my recollections of the Sentemher convcrsh`ion. I now believe that my statements, an they relate to stafr ne- gotint;ons with the DOT, were incorrect. My public statements were bnsed -n faulty information, due to my inability to recall exnctly Llo y. 0 our earlier conversation Prom memory, I am now painfully aware of the unreliability of my informntion, having now the responsibility to sot tie rrcord ntrnight. I nssure ,you t nt this rr.�rettnbin misl.'<e wns not intended as an effort to discredit ,you, other city employees or the city nl.anni.np nrocess, Hither, I think this error might be attributable to the impetuohity of south, which, I trust, will diminish with age, and c•lrelessness. I shall make every effort to base future statements unon writr.on notes and trur.t my memory only Por mundane matters wh.:-e no person's renutation, incli:ding my own, ka at stake, \Sinenrely ,n `)?b -n -LV John hlorrisse 513 Van Bur n#4 lows City, I CC: Heal Berlin Abbie Stolfus Pick Geshwiler OcIty of Iowa Cito MEMORANDUM DATE, October 28, 1977 TO: Neal Berlin FROM: Richard Plastino RE: One -Way Traffic on Hol ywood, East of Keokuk. Approximately 3 months ago a plan was presented to make Hollywood one- way for a short distance to alleviate traffic congestion problems. One group wanted the traffic to be one-way eastbound to eliminate vehicles moving west on Hollywood from cutting in front of people going north on Keokuk. Another group wanted this section of the road to be one-way westbound to eliminate the conflict of left turning vehicles moving south on Keokuk to east on Hollywood. The present system has been in operation long enough to draw some conclusions. These are: 1. The present configuration has eliminated both of the above mentioned problems. With the removal of vehicles cutting in front of north- bound Keokuk drivers, the majority of drivers on Keokuk now stop and allow left turning vehicles on Keokuk turn onto Hollywood. 2. The diversion of traffic through the K -Mart parking lot has not been serious. Discussion with the K -Mart Manager reveals that they have had no undue problems. The increased traffic through the lot was not as much of a problem as they thought it might be. The one- way situation on Hollywood has "not been that bad". The Manager has no real recommendation as far as alternatives or whether the one-way should continue. 3. Time-lapse photography was done on the 'before' and 'after' situation at the intersection. These did not prove to be of great value in analyzing delay, except in a general way. 4. Observation of the intersection reveals that it is working well with less traffic confusion and less delay. 5. There is opposition to the one-way system by tenants of the Colonial Park Office Building. 6. Discussions with the Manager of the Iowa State Bank and Trust reveals that they have three preferences: (a) take the island out and return it to two-way traffic. (b) leave it the way it is but make the one-way lane a few feet wider. (c) make Hollywood one-way from Keokuk to only the first entrance into the drive-in bank. This would allow traffic from east of the bank to reach the bank via Hollywood. There would appear to be four options that now exist: 1. Reverse the traffic flow to one-way westbound. No one favors this. 2. Remove the island entirely and let the situation revert to its former status. Iowa State Bank and Trust would agree with this. 3. Reduce the length of the island so that it only goes to the first drive-in to the bank. The bank would agree to this and much of the opposition from the Colonial Park Office Building would be eliminated. 4. Leave the situation the way it is. Three of the alternates probably should be considered by Council. These are: 1. Tear it out. 2. Leave it as is. 3. Reduce the size of the island so that it goes to only the first entrance into the Iowa State Bank and Trust. Public Works will await direction from Council on this matter. cc: J. Brachtel Eliot A Keller, KRNA B. Summerwell, Iowa State Bank & Trust K -Mart Manager City Council Colp-tial Park Business SeZrvice 1027 Hollywood Blvd. Iowa Cite. Iowa 622.10 (319)338-8800 October 31, 1977 Richard Plastino City of Iowa City Iowa City, Iowa, 52240 Dear Sir: We are in receipt of a copy of your memorandum dated October 28, 1977 regarding the One -Way Traffic nn Hollywood, Bast of Keokuk. The reason for my letter is to pofnt out that there is :1 I:u'ger traffic situation involved than the corner of Hallvwood and Keokuk. 'this is the corner of Taylor and Highway 6, involving people visiting our office building to do business with one of our tenants as well as the tenants themselves. This is the problem caused by trying to cross over Ilighway 6 to go west. especially at the speeds the traffic moves along this stretch of the road. Also traffic is either forced to use the Taylor exit or go down Hollywood through the residential Sections, where thore arc several children playing, to Sycamour to the stop lights. Plus the fact that one cannot go into the drive -up windows at the bank, unless you go out Taylor, cross the highway, down 1. block to Knekuk cross all the traffic lanes again and come into the hank, or go up Ilnll}•wrond toward Keokuk, through the K -Mart Parking lot out the end exit around the street and into the Bank - now you may think using the parking lot sastem is a safe alternative - but you should be in our situation of being forced to use it and drive through the traffic around noon and from ::30 to 5:30 and you will see how SAFE i[ is. Going through the One -Fay section into the bank, when [herr is no t'.iffir coming the other way, may not be legal, but several people do it. Mien people see your picture -taking equipment sitting in the K -Mart parking; lot - they are not about to go through the One-6;ny lone the wrong direction. As narrow as the strip of street is on the One -hay section, is the snow plow equipment going to be able to get through to clear the traffic lane?? I urge you to consider your decision very carefully, which 1 am sure you will, because this One -bray Island is not solving the traffic prnblcias, it is helping on one corner and creating problems on other exits. Yours truly. / v �. , A I— ) " Lit C. Vaughan Manager Col.+ni:nl Park Office:; YO ys- The Laurence R. Saub • suQncy The Penn Mutual Life In .. "Company Colonial Park Building. Suite 315, 1027 Hollywood Blvd- Iowa City, JA 52240 Bus. (319) 3515050 Res. (319) 338.0906 DPenn Mutual John W. Swenson District Nlanaocr The Laurence R. Saub.ncy • The Penn Mutual Lite Insul -ice Company Colonial Park Building, Suite 315, 1027 Hollywood BIW„ Iowa City, IA 52240 Bus. 13191351.5050 Res. 13191338.0906 Penn :! Mutual John W. Swenson District Manager hili (�l)�7i1h�C�•O�� .. u.1Z+Qy_ � �� .�� �z�.o.-...� n-•�-.,q�Q /:L2c�L.tz.l��_ .w-t.L'`- _ COVc i-6 I I RECEIVED OCT 3 10 LAw Orncc9 Or LEFF, LEVY, LEFP 9E IIA PERT ARTHUR O.Lerr ERE SOUTH UNN STREET - P. O. SOX ) PHONE 338-7991 PHILIP A. Lerr IOWA CITY, IOWA AREA CODE 319 ALAN R LCrr 52240 R.ORUCC NAUPCRT October 27, 1977 Mr. Neal Berlin City Manager Civic Center Iowa City, Iowa 52240 Re: DRC Dear Neal: I am enclosing a copy of the minutes of our meeting of the Design Review Committee and have forwarded a copy of the same to Paul Glaves. I am forwarding these minutes to you so that you will be up to date regarding the approval given to the College -Dubuque plans and particularly the action taken regarding the kiosks. You will remember that several council members expressed concern regarding the design of the kiosks. You will note that the only change in the design was a lowering of the roof line by 12 inches. If you have any questions, please advise. RBH:sf Enc. cc: Mr. Paul Glaves Sincerely, LEFF, LEFF, LEFF 6 HAUPERT R. ruce Haupert Z/016 O DE'SICN REVIEW COMMITTEE. MRIi'IING A moeti.ng of Lit(, Design Itevlcw Committee was held in Room I1 of Lite Reereat.Lon Center in Iowa City, Iowa, on October 26, 1977. The meet - Ing commenced at 4 P.M. and concluded aL 6 P.M. J4'enent: were Dill Keating, and Paul (:laves of the CLty Redevelopment Office, .lack Leaman of Engineer- ing Associates, and the fol.lowtng, members of the Design Review CommitLee: .11111 Vockenfitss, Robvrt Alexander, Brian Cutheinz, Annette Lilly, Joyce Summerwlll, Lawrence La oro, Don Sinek, Nancy SLeberling, Tom Wey,mon, and lircu:e Ilaupert. Jack Lemm,ui gr.,vt- it prosa•ui alion ol. Ihv Cul Ivil. -11116 uqur Sti'�h•C pedesl.rinu ma Ll construct.Luu projeuL and explaluvd in detail Lhe final plans. Numerous questions were asked by members of the Design Review Com- mittee and answered by Mr. Leaman. It was suggested and the suggestion was .agreed to by Mr. Leaman to lower the roof on the kiosk: by 12 inches thus reducing the over-all heightll of the structure.by 12 inches. The concern of some of the members of the City Council concerning the design of the kiosks was discussed in detail. It was the consensus of the members that the kiosks are difficult items to design but that, basically, they amount to a box or cylinder wLth some form of top. It was felt that their design must be somewhaL remarkable in order to avoid an appearance of a structure wtthout a purpose thereby creating n cluttering effect. Much concern was expressed regarding a focal area mud Its nbsence of a free flowing, design. A popular suggestl.on would require submerghip. the granite block to n level flush with the resL of the focal, area so that the granite block would not protrude above Lhe level as it is now designed. Mr. Leaman indicated that his design was completed In Lhat respect and that subsequent changes could be made but that they would have to be made by the citizens committee headed by Tom Wegman. Since the presentation by Mr. Wegman of the proposed treatment for the focal area was to be given Inter in the evening on October 26, discussion was terminated until such time as details were known to the Design Review Commission. Upon motion duly seconded, a unanimous vote was cast in favor of the final plans as presented by Mr. Leaman with the exception of the change noted above regarding the kiosks design and subject to subsequent redesign of the focal point area. Various members of the Design Review Committee expressed consider- able interest and knowledge concerning the free-flowJng banners which might be used on the six anticipated flag poles. Apparently, such banners can be and frequently are extremely beautiful. I requested that before n nCIOC- tion of the banners lie made, the Design Review CommltLee members be consulted in view of the considerable expertise in this parlA rul.ar area possessed by several members of the Design Review Committee. -z - A prosottlal I,m was mado by ?b•ssru. Rr•n;: and Kruno cuuccrning Ih.• Cullcit'• block bul Iding• de141ga mid III(- dc:ilgn ul the harbor chop to bp• ru:u:l.ructod next lu 'I'll Illy,,, 'rhIngn h 'I'llIngs. A prcllmluory cxtcrlor :.L•ntc.h of tic ColLegc block bullding was shown. The rontorotion of Iln- bnildLug, of course, was very accepLabLc to the members of the Design N.eview Committee. They expressed inLerestin seeing, only Cho designs for ::Igaage and the paint color ultimately selected for Lhe exterior. Hr. LaFore expressed interest in the color of paint and there was unani- mous interest in the kind of sign sel.cct:ed for the bui.lding. One sugyes- t'ion was gold leaf lettering on the window. This suggestiun was made by Larry LaFore and in view of his historical expertise in thi.s area, ::uch a suggestion might be given weight. No design for the barber shop was presented. it was suggested by several members of the Design Review Committee that a set -back be employed with appropriate treatment given to the sidewalls of Itosheks and 'Things, Things 6 Things. A small but very Inviting and interesting courtyard was suggested as a possible ulLl.ization of the set -back area in order to avoid construction to the sidewalk line as Is usually the. case. This would result in architectual variance and interest. The rueeting was duly adjourned. R- ISruce Ilaupert, Chairman 0 0 MINUTES OF STAFF MEETING October 26, 1977 Department referrals from the informal and formal Council meetings were distributed to the department heads (copy attached). Some months ago an arrangement was made with the University whereby City employees would not have to feed the meters when parking on campus while driving a City vehicle. The University wrote to the City Manager noting that the arrangement is working well and the policy will continue. The City Manager asked the staff if they had encountered any problems. None were mentioned. The staff was asked for comments concerning the plans for a bi-weekly payroll. Input should be given to the Personnel Specialist. The City Manager mentioned plans for an annual report which will go to the public. Rick Geshwiler is doing some preliminary work on this. This report will cover two areas: 1) What has been going on in the past, and 2) major direction of the City and the budget for next year. The City Manager asked if any members of the staff have had problems with equipment maintenance. The Police Chief mentioned the problems associated with pumping gas at the service building. The City Manager mentioned that the Purchasing Agent was asked sometime ago to do a study on the cost of maintenance on the Novas but the results of this study have not been received. The Finance Director was asked to remind the Purchasing Agent to get these figures together. The subject of special recognition for employees who have reached the top of their range was discussed. The staff was asked to submit their ideas to accomplish special recognition other than reclassification. This subject will be on the agenda for the staff meeting for November 9. The Director of Parks and Recreation advised that a memo will be going to all employees regarding the Holiday Party which will be held December 3. Tickets will be sold and a receipt will be issued for the gross amount from each department. No individual receipts will be issued. The Director of Community Development mentioned that the employees have been holding bake sales to raise money for door prizes. He suggested that the department heads prepare something for the last bake sale which is to be held November 17. A note will be sent to all department heads. The City Manager advised that he will be out of town attending the annual ICMA conference from Thursday, October 27, through Friday, November 4. The Director of Public Works will be actino city manager during his absence. The City Manager advised that an organizational change is being made in the Department of Human Relations. Candy Morgan will concentrate on collective bargaining. June Higdon will handle all on-going personnel matters to be directly coordinated with the City Manager's office, mainly with the Administrative Assistant. Sophie Zukrowski will handle matters of the Human Rights Commission with Candy Morgan. She will also be implementing some long-range programs. On those she will deal with the Adminis- trative Assistant. The City Clerk has a new request form which should be used when requesting detailed information. G 0 The City Engineer asked about the plan to have microfilming. The Finance Director advised that it is still in the process of analysis. The City Manager requested the Finance Director to get with the Purchasing Agent to come up with something concrete. A brief discussion was held about items pertaining to the budget - whether departments will be charged back for the work done in the Word Processing Center (yes), whether departments will be charged for the car pool (aiming to go to a centralized motor pool), and method for budgeting for building maintenance and repair. The City Manager advised that requests for repairs and remodeling should be submitted to the City Engineer and these should be budgeted for in Government Buildings. The advantage of having these items in Government Buildings is that we will have a better feel of what is really needed. The Purchasing Agent can be of assistance in budgeting for these items. Prepared by C;ZY4�1� Lorraine Saeger I INFORMAL OCTOBER 24, 1977 DEPARTMENT REFERRALS SUBJECT DATE REFERRED DATE ¢W % RECD TO DUE 22. o COMMENTS/STATUc WE W ¢ Cost of Sunset Street 10/24 PUB WRKS For Councilor Balmer HCDA - grant - housing acquisition - identify source C E refer to CCN 10/24 COMM DEV Discuss with Old Cap the use of Block 83-84 for snow storage. COMM DEV 10/24 PUB WRKS Prepare resolution for Downtown Commission 10/24 LEGAL Hold distribution of housing code until Va November 8th. Refer to Housing • Commission for recommendations 10/24 HOUSING Print newspaper recycling notices on water bills. Prepare publications 10/24 11 FINANCE Keep agenda short on November 8th 10/24 CTY MGR Election - City wide vote on District B 10/24 CTY MGR Prepare publicity. CTY CL Update report on Scott Blvd 1110124 II PUB WRKS II II II II • • INFORMAL OCTOBER 24,19» DEPARTMENT REFERRALS SUBJECTRECD DATE REFERRED DATE a w COMMENTS/STA To DUE W Q Status of Old Jet 10/24 CTY MGR Vet group more suitable monument 10/24 CTY MGR Revise application for Brds/Commissions rrFy rLB to include conflict of Interest 10/24 C AIGRK Investigate city truck out Hwy 6 at noon and back at 1 or 2 p.m. 10/24 Hold neighborhood meetings with resident; near Court B Muscatine bridge for citizei input. 10/24 PUB WRKS Review ordinance language for Board of Appeals. (length of time for appeals) 10/24 LEGAL Policy for maintaining islands in ROW PARKS Whose responsibility? 10/24 PUB WRKS • • DEPARTMENT REFERRALS FORMAL OCTOBER 25, 1977 W } SUBJECTRECD DATE REFERRED To DATE DUE Q w F COMMENTS/STATUS LLI W M Determine date when objections to the Bldg moritorium have to be filed in the City Clerk's Office. 10/25 LEGAL Send notices to prospective applicants for the Board of Appeals 10/25 Comm Dev Sidewalk in front of Seville Apts is not barracaded. 10/25 PUB WRKS Dorothy Maurberry, 217 Magown. Drainage ditch pipe exposed.from recent work ther 10/25 PUB WRKS Breakdown of Federal money. (Des Moines Register article). 10/25 FINANCE Legal opinion regarding the building moratorium. 10/25 LEGAL Coordinate recycling newspaper pickup with advertisements. 10/25 PUB WRKS Prepare ordinance prohibiting others from collecting newspapers. 10/25 LEGAL 30 Lincoln Ave. - Univ pine trees close to lot line when needles drop (Notify Bob Vevera) can't plant garden. 10/25 PUB WRKS (City -University meeting) • • FORMAL OCTOBER 25, 1977 DEPARTMENT REFERRALS G' SUBJECT DATE RECD REFERRED m DATE DUE ¢ W -2 F COMMENTS/STATUS UJ Defer resolution regarding policy for oiling dirt and gravel streets for 1 wk. 10/25 CPY CLRK PUB WRKS Send list of dirt and gravel streets to council. 10/25 PUB WRKS 1304 Franklin Street. Storing junk in yard. 10/25 HOUSING LEGAL (Notify Bob Vevera). 0 CITY of IOWA c QTY CIVIC CENTER 410 E. WASHINGTON ST IOWA CITY IOWA 52240 (319) 354.180J October 28, 1977 Dear Resident: Approximately one year ago the City inspected all bridges in the City to determine their structural soundness. The bridge at the intersection of Court and Muscatine was found to seriously deficient and it was posted with a load limit of five tons. The City is anxious to replace this bridge and a Consultant has done some preliminary engineering. Before going any further on this project we would like to present facts about the project so you can be aware of what is happening and also aid the City Council in some decisions which must occur in the near future. In order to familarize you with this project we would like to meet with you on November 9th, 7:30 p.m., in the Library at Hoover School. If you have any questions about this please feel free to contact me. Sincerely, i rPlastino D ctor, Public Works cc: Neal Berlin City Council Bob DeWitt, Shive-Hattery /Is g6LIS 0 0 Court and Muscatine Bridge letter sent to residents at: 1302 Muscatine Avenue 400 Grant 200 Fairview 1303 Muscatine Avenue 406 Grant 222 Fairview 1307 Muscatine Avenue 409 Grant 223 Fairview 1308 Muscatine Avenue 410 Grant 224 Fairview 1311 Muscatine Avenue 416 Grant 226 Fairview 1312 Muscatine Avenue 417 Grant 227 Fairview 1315 Muscatine Avenue 419 Grant 231 Fairview 1316 Muscatine Avenue 422 Grant 306 Fairview 1319 Muscatine Avenue 423 Grant 309 Fairview 1320 Muscatine Avenue 426 Grant 312 Fairview 1322 Muscatine Avenue 435 Grant 315 Fairview 1326 Muscatine Avenue 436 Grant 316 Fairview 1328 Muscatine Avenue 317 Fairview 1330 Muscatine Avenue 1190 E. Court 320 Fairview 1331 Muscatine Avenue 1206 E. Court 321 Fairview 1335 Muscatine Avenue 1211 E. Court 323 Fairview 1424 Muscatine Avenue 1212 E. Court 334 Fairview 1427 Muscatine Avenue 1220 E. Court 335 Fairview 1500 Muscatine Avenue 1302 E. Court 1502 Muscatine Avenue 1309 E. Court 1506 Muscatine Avenue 1402 E. Court 1509 Muscatine Avenue 1412 E. Court 15094 Muscatine Avenue 1515 E. Court 1510 Muscatine Avenue 1519 E. Court 1514 Muscatine Avenue 1521 E. Court 1518 Muscatine Avenue 1525 E. Court 1519 Muscatine Avenue 1524 Muscatine Avenue 421 Rundell 1526 Muscatine Avenue 425 Rundell 1527 Muscatine Avenue 435 Rundell 1530 Muscatine Avenue 441 Rundell U.A.Y. MONTHLY REPORT — SEPTEIMEH, 1977 I September is a crucial month for the outreach program. With the schools reopening it is imperative that we coordinate our services with IV school personnel, and develop cooperating relationships, especially with IV" school guidance counselors. Thi= September was especially important because of the county -wide expansion of outreach. As a result of county p expansion, we are involved with three additional school districts: Lone Tree, Solon and Clear Creek, each with its own set of rules, regulations, C,) and procedures that affect students. IWe met with school personnel from each of the rural districts and V- had very positive results from each meeting. Their input indicated a need for rural outreach, and they were eager to begin using us as a resource in helping students, especially those having difficulty in and Q out of school. 11 N We also completed meeting with Iowa City school personnel. Their N understanding of U.A.Y. and how to utilize our services is the best I have seen since coming to U.A.Y. I think their understanding is a direct result of the rood working relationships we maintained with counselors last yecr. Several schools will be offering peer counseling programs 3 this year for the first time (City High began one successfully last year). We are especially looking forward to working with these programs as a — valuable resource, and may he involved in come of their training. +, As a result of out initial meetings in the schools, the tutoring V proSrem is off to a good start. In years past we have not gotten referrals until well into October, but this year referrals began coming in within two weeks of school opening. 'r.'e are fortunate to have Dorie 3 Niekelsburg, a volunteer from last year, return to coordinate this year's tutoring program. Dorie is a :octal Work student at the University and o will receive credit (finally) for some of her volunteer efforts at U.A.Y. — We We still need volunteers, so contact Dorie if you know of someone interested. clWe had a very successful Open House on the 21st, and we thank all of you o% who helped. 1I'e are particularly grateful to the Hoard of Supervisors for Co showing such an active interest in the work we do with young people. X We have increased our involvement at the Dark IV apartments. The need 0 for services there, especially for children and adolescents, seems critical .D since the neighborhood center is unable to effectively provide all the I services necessary to families. We are working with their staff and students in providing services to adolescents. We would like an outreach aide to be available there on a daily basis, and hope to do so when their training is complete. united action for youth alternatives for young people — vo v9 t\ co co co D• A 0 0 (2) SEPT. 177 The new juvenile court judge, Brent Haretead, seems genuinely enthusiastic about his work in the juvenile court. Some changes in the court have occurred and more are likely. His short time on the bench has already improved the quality of court services, and we hope to con- tinue as an effective resource to the court in dealing with delinquent youth. The C.E.T.A, contract ended this month and beginning October 1, Susan's salary will be picked up by the L.E.A.A. grant. With all our attention on the county expansion, we need to be care- ful not to overlook the existing city outreach program. In October I would like to address two areas of concern with regard to city outreach. The first is our declining involvement at the Iowa City Recreation Center. With the school year program starting however, we need to renew our involvement at the Recreation Center especially as the colder weather approaches. I hope to meet with their regular staff as well as the S.P.I. coordinator, to discuss ways in which we can improve our efforts there and serve each other as effective resources. The second area of concern is effective coordination with the police department. ��e continue to have a good working relationship with Frank Burns and Leo Eastwood, but feel an increased need to at least meet with the uniformed officers and make them aware of our services. I hope to arrange with each shift captain an opportunity to meet the officers of all three shifts and let them know our location and the services we offer. Chief Yiller approves the idea, so I hope to make the arrangements this month. Other happenings in October include continued training for the outreach 3 aides, including a trip to Cedar Rapids and Ames to visit other youth programs. I will be attending the "Juvenile Justice Standards and Goals" conference in 0 Washington D.C. The United Way Campaign Drive will be in full swing and we will have a booth on Mall Day, October 24. We hope to sign our contract with the county and finally , we look forward to the last few glimpses of warm sunny weather. SEPTEMBER TOTALS sof these, 29 were county clients Happy �AAuuttum�n! Jim Swaim united action for youth alternatives for young people 0 1. Youth receiving direct service ........ 94* 2. Youth receiving follow-up ............ 106 3. Crisis Interventions ................. 49 4. Referrals in ......................... 12 5. Referrals out ........................ 14 6. Drug Seminars ........................ 4 7. Completed tutoring matches........... 1 sof these, 29 were county clients Happy �AAuuttum�n! Jim Swaim united action for youth alternatives for young people 0 0 UNITED ACTION FOR YOUTH, INC. Statement of"Receipts and Disbursements Period Ending September 30, 1977 Receipts: CETA City of Ioua City Undistributed United Action For Youth Account United Way Total Receipts: Disbursements: Employer Matching FICA Employee Health and Retirement Funiture and Fixture Expense Workmen's Compensation Insurance Liability Insurance Janitorial h Sanitation Sup lies Miscellaneous (Bank Charges Office Supplies Postage & Freight Professional Fees - Accounting Printing - Outside Salaries - Employees mStaff Development Telephone Transportation Reimbursement Utilities Advertising Supplies Expense - Miscellaneous Total Disbursements: Receipts over Disbursements: Prepared: Peg McElroy Accountant Current Period Year to Date $ 773.95 f 2,185.47 2,648.39 6,948.39 3,626.39 1.500.00 $3,422.34 $14.260.25 $ 169.71 f 521.81 145.10 953.15 6.09 270.00 9.75 19.50 2.44 4.20 21.13 2.89 70.63 .21 42.21 170.00 270.00 .10 23.52 29915.25 10,405.33 1.28 16.28 34.08 110.78 36.90 36.90 175.00 1.00 1.00 2.93 2.93 $3.481.64 $12950.46 ($ 69.30) LIALD9.79 UNITED ACTION FOR YOUTH) INC. Report on Receipte.and Disbursements City of Iowa City Grant Receipts: Current Period Year to Date September 1, 1977 per contract f$2,150.80 $6,450.00 Fund Balance Fiscal 1977 498.39 Total Receipts: ILINDA 00 ILaLBA 39 .,Disbursements: Fixtures/Utilities $ f _131.09 9/8 Ck, 123 McElroy /Accounting 40.00 90.00 9/8 Ck. 126 Petty Cash /Printing .10 23.52 9/8 Ck, 120 Petty Cash /Office Sup. 2.57 9& Ck. 126 Petty Cash /Postage .21 28.56 9/0' Ck. 126 Petty Cash /Sanitation 1.15' 9/9: Ck. 126 InteritateLShopper /Advertise 1.00 •1.00 9/19 Ck. 127 Population Reporter /Staff Develop 1.28 1.28 9/20 Ck. 126 Petty Cash /Misc. Supply 2.93 2.93 9/20 Ck, 128 Petty Cash /Sanitation 1.29 4.20 0/10 Ck, 128 Petty Cash /Office Sup. .32 70.63 9/29Ck, 130 Bell Telephone /Telephone Isles 86.40 9/Z 9 Ck. 131 Blue Cross /Insurance 77.90 582.bO 9/1'. Ck. 126 Schmidt /Salary 400.00 9/1. Ck.. 127 Swaim /Salary 190.00 9%1 Ck. 130 Hayward /Salary 72.00 9/1 Ck. 131 Swaim /Salary 100.00 9/15 Ck. 134 Hayward /Salary 66.00 9/16 Ck, 135 Swaim /Salary 475.00 9/16 Ck. 136 Schmidt /Salary 400.00 5.329.50 Total Disbursements: IIJ50j.636.351.91 Unapplied City of Iowa City Funds: S 299.37 596.48 Prepared: Peg McElroy Accountant 0 General: Police Department Monthly Report October, 1977 0 Complaints from citizens and reports of crime increased in almost all categories when October is compared to the prior month. While the number of assaults declined moderately, most other categories of violent crime, including rape increased. A total of 2,360 citizen generated requests for police service was received. In addition, officers responded to 130 false alarms and unlocked 167 automobiles. The number of arrests effected or citations issued totaled 2,369. Traffic citations accounted for 1,994 of this total. The Detective Division was assigned or initiated seventy new cases. Ten cases were cleared by arrest. Fort cases were closed by investigation or by referral to other agencies. A special community problems team composed of Sergeant Evans and Officer Fowler was established. The team will concentrate its efforts on target crimes, those of special and increasing interest in the community. The special emphasis at present is rape and sexual offenses. The team has made three arrests for these crimes over the past couple of weeks. Our colleagues in the other processes of criminal justice ---the courts ---put them back on the streets within four hours of the arrests. But, ours not to question these paragons of justice if not virtue. Animal Control officers responded to 14S requests for service, issued 31 citations, and in general, continued their fine efforts. Statistical summaries are attached. Personnel: Officers attended 1200 hours of special classes pertaining to the new criminal code. An additional 160 hours of training was afforded four officers at the Davenport Police Academy. Sergeant David Harris was transferred from the Detective Division to the position of supervisor for the late night shift. Officer Richard Murphy announced his resignation from the Depart- ment effective November 13, 1977 after fifteen years as an Iowa City Police Officer. 0 0 Police Department Monthly Report - October, 1977 -2- Officer David Arkovich was assigned to ASAP effective October 25, 1977. Officer Gerald Knock, formerly of the Marengo Police Department was hired to replace Arkovich. Officer Bruce Bartels was hired effective October 25, to replace Patricia Klug who resigned some months ago. Two officer vacancies still exist within the Depart- ment and will be filled as soon as all the baloney for Civil Service hiring can be accomplished. v. ANIMAL SIICL'1TR MOM'IILY REPORT • MOM7I ne— �2 e r 17 This Month '191is vionth This Year Inst Year (I.isL Ye'u•) to Date to Date D)g Caliplaints Cat Canplaints Total laints Impounding Recozd Voluntary (Dogs) Pick up (Dogs) Owner (Cats) Stray (Cats) ell 90 9 Disposals Dogs Adopted Dogs Reclaimed Cats Adopted Cats Reclaimed SUI D OGJ 191 ,t3 R,c .4 q SUI CATS 17 P.T.S. Dogs P.T.S. Cats Rev • ue (in dollars) Adoptions SUI I Undin or�crjr 10 - no J°.J c sa !2 e 00 pa r• : %OC0. 'CPS•. Tickets Issued -o c Other Animsls Picked Up Paccoon Opposum Mrs Birds, Fowl Wild, other Skunk Livestock Other y , , ' , Dog Bites Other Bites Cat Bites yN•�-••-•� +� c; +y E.9 Rabies (Confinned) o Dead Animals Picked U 5 y Dumped cl3 Bikes C+ y S COMPLAINTS RECEIVED BY POLICE 1, CRIMINAL HOMICIDE L. 2. RAPE 3. ROBBERY 4. ASSAULT 5. BURGLARY 6. LARCENY 7. AUTO THEFT 8. OTHER ASSAULTS 9. FORGERY AND COUNTERFEITING 10. EMBEZZLEMENT AND FRAUD 11. STOLEN PROPERTY 12. WEAPONS 13. PROSTITUTION 14. SEX OFFENSES 15. OFFENSES AGAINST FAMILY AND -CHILDREN 16. NARCOTIC DRUG LAWS 17. LIQUOR LAWS 18. DRUNKENNESS 19. DISORDERLY CONDUCT 20. VAGRANCY 21. GAMBLING 22. DRIVING WHILE UNDER THE INFLUENCE OF LIQUOR 23. VIOLATION OF ROAD AND DRIVING LAWS 24, PARKING VIOLATIONS n .i.�i._ .tl. :•ii:C. nl'::. �'ii��. JL... mob...:... �.. .�..:'. t1.. :) 0 0 0 0 0 0 1 0 ! 1 0 I p i 0 1 1 3 0 12^0 1 0 1 2 0 13 I 0 3 1 2 �0 4 5; 1 2 1 11 6 4 11 12 4 114 1 7 i 13 9 21 38 37 28 1 38 1 52 37 141 34 132 I i 82 101 125 18J9, 82 1165 1173 1 18411751179!: 21 7 17 E4 1 39 I 24 25 18 132 ;41 0 0 0 0 0 10 0 10 0! 0' 4 7 6 9 10 i 1 j 4 j5 15 111 32 25 9 17 16 12 113 15 11 120 0 1 0 0 0 2 1 1 !0 ; p! 0 0 01 11 0 OI 0 10 0 0' 0 00 0 0 1 0 1 ;p O p 5 9 1 12 6 2 8 13 j21 117 17 ' 39 31 45 1 38 11 47 . 55 145 � 43 ! 48 '37 3 11 3 7 17 12. g 1 6 5 i 8 1 O 4 1 3 i 0 S 1 ! 0 3 4 22 14 13 19 25 i 13 9 9 22 i18 45 51 37 154 148 60 169 167 131 i39 0 0 0 0 1 0 0 0 0( 0 I p' 0 0 0 0 0 1 0 0 0 t 0 ! 0 ' 24 33 38 ( 22 151 124 128 117 j22 '20 14 16 24 46 ;47 43 '38 !35130 34 292 253j209 264 1181 203 '153 I1 !2 '260 I!CCOTI V1:II!C11 ice" :S: ?7. s�szlclel:: 2".•. L^ST: 29. FOUM 310. ^AT:"L YOTO!1 !'rI IICL?: T U"T "TC ACC..M1 ;!TS : 31. ": `0!.`;.T ^d.il•Tl !•� U^. VEll-CM, TRA'.TIC ACCID!:"r,,: 32. :1(ro". VL}IICLr TIUXPIC ACCItDE17PS: 33. OT:L•^. Trio ?'C ACC^'L•'!!TS: 3!f. 35. •!!0'" ACC:-l"Es: i AT:'1:!'=D: 1;1 SCDDM! DEA71 VD P.ODi.'S F01:11D: 11-M L CAPE: !:!1. PO'PM TIRVATS: !:r. Jlr%17!:L?S: 52 I 35 I 33 I 23 I 35 1 33 ! 20 133 I 41 1 33 886 831 1 958 11191 1143 1055 954 11025 988 P05 19 29 78 87 96 75 1 83 1 61 1 65 69 45 45 34 62 52 55 64 49 47 66 25 38 88 1 124167 1491126 25 118 107 11 0 0 0 0 0 0 0 0 0 1 •I 14 14 16 28 19 24126 30 28 33 1 269 128 116 142 127 121 16 1471194 195 0 0 0 0 0 0 0 0 0 2 0 0 1 0 1 1 0 1 0 1 1 1 1 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 34 58 77 162 71 60 81 49 44 44 1 0 0 0 1 0 0 1 1 0 0 3 2 0 0 0 1 0 1 0 0 3 1 1 0 4 3 1 IO 0 1 I 1 13 6 5 3 4 0� 1 3 3 2 7 1 12 6 2 5 3 4 1 3 2 2 0 1 1 0 0 2 1 23 32 62 76 78 881155 4 52 ( 64 18 16 21 22 it 25 114 6 10 8 12 4 2 1 1 I O 01 0 0 1 1 2 T L 1 nnn .nc� no ern c,o Inco. hoof 97AR gAnb'a,)rh8O ARRESTS MADE BY POLICE 1. CRIMINAL HOMICIDE 2. RAPE 3'. ROBBERY 4. ASSAULT 5. BURGLARY 6. LARCENY — THEFT 7. MOTOR VEHICLE THEFT 8. OTHER ASSAULTS 9. ARSON 10. FORGERY AND COUNTERFEITING 11. FRAUD 12. EMBEZZLEMENT 13. STOLEN PROPERTY Buying, Receiving, Possessing 14. VANDALISM 15. WEAPONS Carrying, Possessing „etc. 16. PROSTITUTION AND COMMERCIALIZED VICE 17. SEX OFFENSES 18. NARCOTIC DRUG LAWS 19. GAMBLING 20. OFFENSES AGAINST THE FAMILY AND CHILDREN 21. DRIVING UNDER THE INFLUENCE 22. LIQUOR LAWS 23. DRUNKENNESS 24. DISORDERLY_ CONDUCT d 0,6.. rzo. P./ui. Ara.P4,1. o�:... Vb...:: �... .1..� W.. 0 0 0 0 0 0 0 I 0 0 I O 1 1 1 l 0 0 O I O 0I 0 0 I 0 i 1 0 0 0 0 0 2 0 1 3 2 8 4 6 3 j 3 7 I 0 0 5 0 2 0 3 1 1 1 2 1 0 0 8 9 15 9 12 174 17 110 13 0 0 0 0 1 i 0 I 0 I 0 ! 0 1 0 1 7 4 4 3 I 3 17 0 1 15 t 0 0 0 0 0 0 I 1 i 0 j 0 i 0 I I 1 0 0 1 2 1 1 1 1 I2 0 1 ^ 0 I 3 2 I 0 0 I 3 0 0 0 6 1 0 I 0 I O I 1 0 I 0 0 �0 0 IO 8 9 16 I11 112 11 8 14 I5 112 I13 0 3 I 3 2 0 5 0 10 1 3 0 0 0 0, 0. 0 1 0 1120 I O 0 0 0 0 0 I 0 j 0 10 1 0 10 0 0 3 0! 0 `. 0 1 0 10 i 0 10 1 4 0 2 5, 3 2 127 I O 14 0 I 1 I 0 0 0 I 0 I 0 1 0 0 0 10 0 I 0 I I 0 i 0 0 0 0 0 i 0 0 15 17 15 1 28 114 16 113 i 14 i15 1 1 0 116 p i 0! 0 2 I 0 i 1 I1 10 99 :16 ' 7 ill 8 1 3 i 8 :lr ^� 3 6 4 1 5 1 2 1 5 10 114 17 17 25. VAGRANCY 26.7 ALL OTHER OFFENSES (Dog calls, Criminal Trespass, etc.) 27. SUSPICION 28. CURFEW AND LOITERING 29. RUN AWAYS 30. TRAFFIC 31. PARKING TOTAL ARRESTS oI 20 0 o i 0► O l p p i0 i 341 47 167 58 I 49 188_1 34 131 125 140 0 0� o l o I o I o I 0 I p i0 0! 0. 0 1 p D j o I o i 0i 0 0 I 0! 0 0! 0! 0! 0 1 0 9 I p i 0 i 135 435 4921 470 343 1198 12821297J1297I 247; j 1681 207 11820 901 .658 ! 741 !1721125941994; 19071263J,2331 11597 12424 1369!1008 123 12 :34297( 369 , ill�l I I _ I � ' i 1 i � I i 0 E 0 AGENDA IOWA CITY PARKS AND RECREATION C01414ISS1014 RECREATION CENTER ROOM B NOVEMBER 9, 1977 - 7:30 P.M. 7:30 - 7:35 p.m. -- Approval of minutes. 7:35 - 7:45 p.m. -- Public discussion. 7:45 - 7:55 p.m. -- Park Naming Sub -Committee - Mascher, Stockman. 7:55 - 8:05 p.m. -- Other committee reports. 8:05 - 8:20 p.m. -- Recreation Division Goals and Objectives - Lee. 8:20 - 8:50 p.m. -- Commission Goals and Objectives. 8:50 - 9:00 p.m. -- Camp Cardinal - Showalter. 9:00 - 9:30 p.m. -- Land acquisition - Showalter. 9:30 - 10:00 p.m. -- FY 79 Budget. 10:00 - 10:10 p.m. -- Other Business. 10:10 p.m. -- Adjournment. 110.51 0 9 AGENDA IOWA CITY RIVERFRONT COMMISSION RECREATION CENTER - ROOM A NOVEMBER 9, 1977 - 3:30 P.M. Item No. 1 - Meeting to order; roll. Item No. 2 - Approval of the minutes for September 14 (joint meeting with the Parks and Recreation Commission), September 21, and October 9. * Item No. 3 - Discussion of proposed budget for FY 79 (see attached information) and Riverfront Commission priorities. Item No. 4 - Appointment of Commission members to the Johnson County Land Use and Water Resources Committee and the Waste Water Facilities Committee. Item No. 5 - New Business. Item No. 6 - Adjournment. * Since budget proposals must be submitted by November 21, 1977, it is essential that there is a quorum at this meeting. PLEASE make every effort to attend. NOTE CHANGE IN DATE AND MEETING PLACE. yoS/ • ! johnson county ®UD regional planning commission ®® 1/2 'south dubuque street, iowa city, Iowa 52240 (319)351-8556 October 31, 1977 Isabel Turner cw.,w. Emil L Brandt b.ul,. D.I.V MEMO TO: Iowa City Mayor, Council, and City Manager Johnson County Board of Supervisors Coralville Mayor and Council United Way of Johnson County FROM: Pamela Ramser, Connie Echternach Human Services Planning RE: Discontinuation of Crisis Center participation in Transient Program Need for Community Policy on Transient Situation As you may be aware, the Crisis Center will no longer be administer- ing the transient program after January 1, 1978. This program has been administered by the Crisis Center since August, 1975 and has been funded by United Way allocations to the Salvation Army supple- mented with Crisis Center discretionary funds. United Way funds will no longer be available to the Salvation Army as of January 1, 1978. Wesley House discontinued the provision of lodging services to tran- sients on August 15, 1977. At that time the Salvation Army proposed a program for lodging and related services at a cost of $68,000 for the first year of operation. This program was far beyond the ability of United Way to fund and its proposal raised questions regarding in- direct funding of the transient program, that is, funding through the Salvation Army to the Crisis Center. United Way decided to discon- tinue funding to the Salvation Army for transient services with the intention of providing some funds to a community program in the future if such a program were developed. The Crisis Center has been involved in the provision of lodging to transients at local rooming houses and motels since Wesley House dis- continued lodging services to transients. The funding which United Way alone has been able to provide was sufficient to cover only the cost of direct assistance before the change in Wesley House policy. The Crisis Center has had no source of funding for administration of the program and, since the implementation of the interim program, the funds which United Way is able to provide are not sufficient to cover the entire cost of direct assistance. Z/40 5:2 The decisions of United Way and the Crisis Center to discontinue funding and administration, respectively, of the transient pro- gram were made in the hope that agencies in the area would attempt to find a more adequate permanent solution to the transient situation. Services for transient persons in need will only be available for two more months. The need for these services is a critical one. About 50 individuals per month have been provided food and lodging vouchers by the interim program established by the Crisis Center August 15, 1977, when Wesley House discontinued the lodging of transients. The Crisis Center sees no prospect that this number will diminish in the future. We anticipate that the number of tran- sients seeking assistance at individual churches, sleeping in cars or hallways, etc., will increase and that some people may resort to vandalism and theft if no provision for services is made. Others may simply be left with no food and no place to stay. The number of transients in the Iowa City area is beyond the capacity of indi- vidual churches to handle. We urge you to consider this situation carefully. There is an im- mediate need for the establishment of a policy and program relative to transient assistance by January 1, 1978. A minimum budget, which the Crisis Center has developed, which would allow provision of assistance at the present level (using rooming houses and motels for lodging) is about $10,000 per year. The budget proposed by Transient Services, Inc. for a central lodging facility is about $28,000 per year. We recommend that potential funding bodies and interested service agencies begin to meet at an early date to discuss this issue. In our opinion it is in the interest of the community to have an agreed upon policy and program to handle this matter by no later than January 1, 1978. Our staff would be available to assist you on this matter. E CITY of IOWA CITY CIVIC CENTER 410 E \,VASHINGTOIv! C7 I,�GV�"� November 8, 1977 Iowa City Board of Adjustment c/o Don Schmeiser Civic Center 410 E. Washington St. Iowa City, Iowa 52240 RE: Appeal of Kenneth Hubel et al. re an Interpretation of Section 8.10.28 of the Iowa City Zoning Ordinance and Section 414.11 of the Iona Code Members of the Board of Adjustment: I am writing this letter to you in connection with a pending appeal that was filed on November 7, 1977. The appeal seeks an interpretation of Section 8.10.28 of the Iowa City Zoning Ordinance and Section 414.11 of the 1977 Code of Iowa with respect to the language concerning the effect of an appeal to the Board of Adjustment. In previous discussions with the Iowa City Council concerning the meaning of this language, I have indicated that I did not feel that the City was under an affirmative obligation to institute litigation and revoke building permits in all cases automatically upon the filing of an appeal. Rather, I have suggested to the Council that the decision with respect to affirmative City action should be made by the City Council and the City Manager on a case by case basis. Before you begin your deliberations in connection with this appeal, I feel it is only fair and appropriate to point out to you the position of the legal department with respect to this appeal. I do not believe that the Board of Adjustment has authority to render a decision on this issue which would be binding upon the City in future cases. In my opinion your authority under the Code is to issue decisions and interpretations in connection with specific cases and I do not believe that the Board has the authority to issue interpretations which could operate in a general fashion and in a prospective manner which could require the expenditure of substantial City fiords for litigation and could potentially expose the City to liability. I believe that decisions of that sort can only be made by the City Council or by the City Manager in appropriate cases. obviously the opinions set forth in this letter are not binding upon you and you can make such decisions and such interpretations as you feel are appropriate. However I did, as indicated, feel it only fair to advise you of my position on this matter. Respectful yo C4i, cc: /owa City Council W. Hayek Dr. Kenneth ]rubel Attorney 0 0 C �•..,� ¢ CENTER nWASHINGTON sr. townCITY. lave,]]a���/CHH 131913L', I" 7, 1977 "Von MARY NEUHAUSER COUNCIL MEMBERS JOHN BAWER CAROLINMOSSE Lf.FOSTER DAVID PENN ET MAX 6EUER ROBERT VEVERA Mr. Jim Mulac 610 South Dubuque Street Iowa City, Iowa 52240 Dear Mr. Mulac: This letter is in reference to your request for the Plains Distribution Service Bookbus to park near the Blackhawk Mini -Park on November 22 and 23 from 9:00 A.M. to 6:00 P.M. It is requested that the bus park inside the fenced area on Dubuque Street next to Blackhawk Mini -park. A member of the Parking System Division will be present to open the gate for you at 9:00 A.M. on both days. When the bus is ready to leave in the evening, please contact the Police Desk at the Civic Center. A City ordinance prohibits the sale of merchandise from public streets. Therefore, sale of the books and magazines from the bookbus is prohibited. Sincer ly yours, !! i� �' Neal G. Berlin City Manager Is cc: Parking System Police Department • • ! 'chlaegel 2ealty Co. REALTORS (fomp/el" Me'd 61,11" Service Jn�urlh2Q 117177 Mr. Bob Bowlin Assistant City Attorney Iowa City, Iowa Dear Bob, In reference to your request for an appraisal for the city of Iowa City of parcels A, B, C, and D (see attached plat) lying in the right of way of Ferson Avenue North of Park Road in Iowa City, it is my opinion that the value of these parcels are $500 each. These parcels are 201 x 1601 each. To the best of my knowledge, after researching all the facts, there is no allowable use for these properties. Their only value is to attach them to the adjoining lots and therefore enhance the overall desirability and value of those properties. The seller therefore is very limited in his marketing of the parcels, his only alternatives are to reach a mutually agreeable figure with the adjoining property owner or hope to sell to a future owner of the adjoining properties. I was unable to find any comparable sales for a property of this nature. In studying this property and its problems, I came across some information which I feel might clarify this valuation. The following is a quote from "The Appraisal of Real Estate," the text of the American Institute of Real Estate Appraisers; "Value is not a characteristic inherent in real property itself, but depends on the desires of man. It varies from person to person and from time to time, as individual desires vary. An object (real property) cannot have value unless it has utility. Utility arouses desire for possession and has the power to give satisfaction. Utility alone does not give an object value. It must also be relatively scarce. So utility plus scarcity are two of the elements 105,5- ARCA COOL' ]IL-TCLLPNONC 330.id 91 CO MPLCTC ALE6 ANO ® 1109 GILBERT COURT. IOWA CITY. IOWA 52240 APPR AILAL vER vlcE REALTOR' NOME a. sARMS. wcR UG[n MCM 6ER OF _ MULTIPLC LIv TING COM MEN LIAL AND .C.yILC IN Ol16T RIAL I.N. AN. BIIILOIN08 GONE A. SCRLACGEL. Mcn. (� October 21, 1977 Mr. Bob Bowlin Assistant City Attorney Iowa City, Iowa Dear Bob, In reference to your request for an appraisal for the city of Iowa City of parcels A, B, C, and D (see attached plat) lying in the right of way of Ferson Avenue North of Park Road in Iowa City, it is my opinion that the value of these parcels are $500 each. These parcels are 201 x 1601 each. To the best of my knowledge, after researching all the facts, there is no allowable use for these properties. Their only value is to attach them to the adjoining lots and therefore enhance the overall desirability and value of those properties. The seller therefore is very limited in his marketing of the parcels, his only alternatives are to reach a mutually agreeable figure with the adjoining property owner or hope to sell to a future owner of the adjoining properties. I was unable to find any comparable sales for a property of this nature. In studying this property and its problems, I came across some information which I feel might clarify this valuation. The following is a quote from "The Appraisal of Real Estate," the text of the American Institute of Real Estate Appraisers; "Value is not a characteristic inherent in real property itself, but depends on the desires of man. It varies from person to person and from time to time, as individual desires vary. An object (real property) cannot have value unless it has utility. Utility arouses desire for possession and has the power to give satisfaction. Utility alone does not give an object value. It must also be relatively scarce. So utility plus scarcity are two of the elements 105,5- 0 0 (Z) creating value. Utility and scarcity togerther do not confer value unless they arouse the desire of a purchaser who has the purchasing power to buy." This appraisal represents the independent opinion of the appraiser free from any present, or future interest in this property, with compensation for employment a fair professional fee. The Appraiser is not required to give testimony or appear in court because of having made this appraisal, with reference to the property in question, unless arrangements have been pre- viously made therefor. Respectfully submitted, G���O'i ti mLss '*1 GD/67?/ S � i Q, Q, V. � a 09 -• '° y d LAP I W' M0�w 1 '-D d 8 oA a." 9, 5 tt r V% u'+�ilS�"k 0 0 t_1 ttie Lwn� s�onn oh'ck��\4t, tid, Y�oZes oS,s0\ Sw0jes; Zv:h�,'�1�¢s �avt. et l�h¢s,�cc��kona exc,e�-t\ion•. 1�c�',he in•t-�¢�oct sed¢ °� a.� VAL-Eoct \'�ht 0% u,�bh�Y�Sor.�U2r�e Yf��l, ri�it Y�o��iv a\so \atth- at°'�hts raovlt�� �lvv.S --Q-. Siuk2s,�� oS� \°� lines , onb� oS� io'C ones �c('�'G� sig ¢.a'V— S�q\1e5, 0,S hn�¢k RUSSELL MANN • REAL ESTATE BROKER DIAL [3193 337.46613 500 IOWA STATE BANK BLDG. January 3, 1977 Mr. Robert H. Bowlin Assistant City Attorney City of Iowa City Civic Center 410 E. Washington Street Iowa City, Iowa 52240 Re: Ferson Avenue Property Appraisal Dear Mr. Bowlin: IOWA CITY, IOWA 52240 Pursuant to your request, I have inspected the following described parcel of real estate: Person Avenue in Black's Park Addition, Iowa City, Iowa, between the North line of Park Road and the South line of Gould Street. Land Size: 60 feet wide by 320 feet long. Less: A strip of land 20 feet in width extending from the North line of Park Road to the South line of Gould Street, the center line of which is identical to the center line of Person Avenue, all as originally designated on said plat of Black's Park Addition. Said strip shall constitute a common driveway and way of access to the lots adjacent to this portion of Person Avenue between Park Road and Gould Street. The parcels of land on which I have made an appraisal are the 20 feet by 160 feet strips of land that lie between the 20 foot access driveway and the adjoining lots numbered 1, 10, 4 and 5. There are several widely accepted methods for estimating the fair market value of real estate. One method is to estimate the highest price which a piece of property will bring if placed for sale on the open market, allowing a reasonable time to find a purchaser who buys with knowledge of all uses for which the property might and, in fact, can be used. A second method is to determine the price at which a willing seller would sell and a willing buyer would buy the particular real estate, neither party being under any abnormal pressure. A third manner in which a fair market value can be estimated is by fixing the price to be expected from the sale of a piece r 0 Mr. Robert Ii. Bowlin - 2 - January 3, 1977 of property if a reasonable time is allowed to find a purchaser and if both the seller and purchaser are fully informed. The final method is to compare recent sales of similar properties. These common methods of appraisal are difficult to use with respect to these particular parcels of land because: 1. The size of the parcels limits their use. 2. The lack of comparable property sales. 3. The lack of any market of prospective buyers, save for the adjacent property owners. 4. The applicable zoning restrictions. S. The lack of access to Gould Street. Taking these various factors into consideration, I have placed fair market values upon the parcels of land by using the following method. The Iowa City Assessor values the land comprising the adjacent lots on Park Road at $90.00 per front foot. Due to the size and limited use of the two parcels of land on Park Road adjacent to lots 1 and 4, it is my judgment that they have a market value of 200 of the current assessed value of the adjacent lots, each parcel therefore being worth $18.00 per front foot. For the two parcels of land adjacent to lots 5 and 10 and Gould Street, it is my judgment that their fair market value would be $20.00 for each parcel. T therefore appraise fair market value of the real estate examined to be as follows (see attached copy of plat for respective descriptions of parcels listed below): Parcel A $360.00 Parcel B $360.00 Parcel C $ 20.00 Parcel D $ 20.00 1 hereby certify that I have carefully inspected the above described property, and that to the best of my knowledge and belief the information and statements contained in this appraisal are correct and that the values stated herein repre- sent my best judgment of the fair market value of the appraised real estate on this date. I further certify that I ]lave no personal interest, present or perspective, in the said LI - 3 - January 3, 1977 of this appraisal of value. I r matters which are of a legal opinion regarding the legal title This appraisal has assumed good Respectfully submitted, Russell Diann 9 • �rq //17177 HUMAN SERVICES STUDY SERVICES TO TRANSIENTS PROFILE October 7, 1977 Emergency Services Sub -Committee Members: David Schuldt - Chairman Jeanette Carter Roald Rolfson Paul Sandin Margaret Stephbnson Staff: Pam'Ramser and Connie Echternach Johnson County Regional Planning Commission 22h South Dubuque Street Iowa City, IA 52240 11056 9 0 TABLE OF CONTENTS Emergency Assistance to Transients GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 TYPES OF TRANSIENTS . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . 2 Service Elements . . . . . . . . . . . . . . . . . . . . 3 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . 4 Hospital patients. . . . . . 4 People stranded while traveling through the Iowa City area . . . . 6 People in Iowa City in connection with the University. . 6 Other groups of transients . . . . . . . 7 Community awareness of the need for, services to transients. . ... . . . . . . . . 7 Statistics on transient population . . . . . . . . . . . 8 POPULATION SERVED/SERVICES PROVIDED. . . . . . . . . . . . 11 History of services to transients. . . . . . . . . 11 Statistics on number of transients served. . . . . . 11 Sociodemographic characteristices of transients served . 14 Associated needs of transients. . . . 18 Referrals to other sources of assistance for transients. 19 UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY . . . . . . . . . 21 Lodging . . . . . . . . . . . . . . . . . . . . . . . 21 Transportation . . . . . . . . . . . . . . . . . . . . . 22 Employment . . . . . . . . . . . . . . . . . . . . . . 24 Food/Clothing. . . . . . . . . 25 Other concerns/general needs for services to transients. 25 Trends in delivery of services to transients . . . . . . 26 APPENDIX 1 Patients Served - University of Iowa Hospitals and Clinics . . . . . . . . . . . . . 28 APPENDIX 2 Age, Sex, Residence of VA Hospital Patients. . 29 APPENDIX 3 Agencies Which Provide Services to Transients. 30 E EMERGENCY ASSISTANCE TO TRANSIENTS GOAL To ensure the provision of minimum basic necessities on a short-term basis during dislocation, emergency, or tragedy. TYPES OF TRANSIENTS There are three basic types of transients in the Iowa City/ Johnson County area. All are composed of individuals/families who do not have resources with which to provide the basic necessities of life for a period of short duration, usually less than one week, (i.e. have no place to stay and/or adequate food provisions, clothing, etc. and are without employment or any means of financial..assistance through which to provide for these needs). A transient individual/ family may be in the area of necessity or by choice. The first type of transient is an individual who is in the Iowa City/Johnson County area for a period of short duration (usually less than one week) and who has a specific "home -base" to which he/she is or will be returning after departure from this area. This type of transient may be in the area either of necessity or by choice. Most often his/her presence here is due to a matter of necessity. Groups of transients of this type in the Iowa City area include: 1) patients at University Hospitals or Veterans Administration Hospital, 2) at- tending relatives or friends of patients at one of the above hospitals, 3) persons returning home from a visit or vaction whose car breaks ..down -unexpectedly or who, due to another emergency situations, run' • • 2. out of money, 4) persons on their way to a job and new place of re- sidence who run out of money due to unexpected expenses, and 5) per- sons visiting the Iowa City/Johnson County area who run out of money. The second type of transient is also an individual who is in the Iowa City/Johnson County area for a period of short duration (usually less than one week) but who has no specific "home -base" to which to return. This type of transient is far less prevalent in the area than the first type. A 1972-73 survey conducted at Wesley House showed that "homeless" transients made up 12 to 20 percent of those staying at the hostel while transients of the first type comprised 80 to 88 percent of hostel guests. Transient individuals are usually in the area by choice. Groups of the second type of transients in the Iowa City area include: 1) young people, mostly males, traveling, for experience and/or adventure and 2) individuals who have chosen a mobile lifestyle. A third type of transient is the individual/family who is seek- ing to establish residence in the area but is temporarily without resources. Since this group is treated in the same way as county re- sidents in terms of eligibility for assistance, it will be dealt with more fully in the section on services to residents. SERVICE AREA DESCRIPTION' These services use a crisis -oriented delivery ststem to meet the short-term basic needs of families and individuals who are in the area for a limited time and who lack sufficient resources to provide for these needs. The intervention provided is usually of short dura- tion and is designed to stabilize the immediate problem .situation. M 0 3, Emergency assistance is given to meet the immediate need for food, shelter, clothing, medical care, transportation, and counseling. Financial assistance is given and temporary employment provided to assist the individual in meeting the cost of basic necessities. Re- ferral to other appropriate resources is also made. Client groups include: 1) patients and attending relatives/ friends of patients being treated at University Hospitals and the Veterans Administration Hospital, 2) families and individuals tra- veling through the area who are without money due to unexpected emergency expenses or theft and are stranded here, 3) families and individuals who desire to establish residence in the area but are temporarily without any means of support, 4) individuals, usually young males, who are traveling for experience and/or adventure and who lack financial resources, and 5) chronic transient individuals. Service 'e1ement's: 1) Direct rovision of basic necessities: food clothing, s elter, transportation, medical care. 2) Financial assistance: for procurement of basic necessities. 3) Counseling: for immediate problem situations. 4) Assistance in locating short-term employment opportunities. 5) Referral to other relevant sources: services which pro- ve a or basic needs in other areas, related services. • PROBLEM DESCRIPTION A 4. Some families and individuals who are not residents of Johnson County but are temporarily in the County do not have the necessary resources to provide for basic needs while here, or to return home or continue traveling to their intended destination. About 1,000 transients per year find them selves in need of some assistance to provide for basic needs while in the area. The majority of transients are in the Iowa City area due to rea- sons of personal necessity (e.g., for medical care or provision of needed support to someone here for care) or due to unforeseen emergency while traveling (e.g., theft, car breakdown, funds run out while traveling to visit sick relative or to prospective job in another locale). Some transients who come to Iowa City for University education or in hope of.finding employment and establishing residence here run out of funds. The presence of so many transients in the Iowa City area is attributable in large part to the existence of the following in Iowa City: 1) University Hospitals and Clinics, which serve the entire State of Iowa as well as surranding states; 2) Veterans' Administration Hospital, which serves 30 counties in Iowa, 23 counties in Illinois, and four counties in Missouri and will accept veterans from anywhere in the country if they are in the area and medical need justifies treat- ment; 3) Interstate 80 which makes Iowa City readily accessible to travelers; and 4) the University of Iowa. Hospital Patients University Hospitals and Clinics and the VA Hospital provide for lodging, transportation, and meals for those individuals in need of medical treatment. 0 0 S. VA Hospital will provide transportation assistance, lodging, and meals to authorized patients from the day before treatment is scheduled until transportation arrangements home can be made. The Hospital has no authorization to provide assistance to an attending friend or relative of a patient, but does refer to the Commission of Veteran Affairs in the home community for assistance. University Hos- pitals provides lodging at Westlawn for minimum care patients, ante- partum patients, authorized escorts, and attendants, upon approval of the attending physician, when space is available. Transportation by Hospital car is available and is financed by state papers for patients on.State papers and their authorized escorts (one escort allowed per patient). Hospital cars can be used by patients not on State papers at their own expense. University Hospitals contacts the County Depart- ment of Social Services in the patient's home county for assistance when financial aid is required. Meal costs for outpatients with sche-. duling problems can be included in the hospital bill. In some cases, a patient and/or attending relative or friend is not eligible to receive aid from established sources. The most common situations in which some other source of assistance is needed are: 1) For husbands or boyfriends of antepartum patients (University Hospitals has no provisions for this); 2) For patients whose transportation arrangements necessitate early arrival (both hospitals can provide assistance only for one day prior to scheduled treatment); 3) In cases where the patient has minunderstood hospital policy on assistance (e.g., patient is not scheduled for treatment but had expected assistance, attendant of patient is not eligible for the assistance he/she had expected); • '6. 4) For expectant mothers who are not ready to deliver on the expected date and cannot retun home and come back again. People Stranded while Traveling Through the Iowa City Area Families and individuals traveling on Interstate 80 are sometimes stranded in the Iowa City area without resources to provide for basic needs. Some outside source of assistance is needed to enable them to continue to their destination. The most frequently occurring situations which cause people to be stranded in the area without resources are: 1) Money stolen on the road; 2) All money used for car repairs; 3) Traveling to visit relative and ran out of money; 4) On way to prospective job/new residence and ran out of money. In some cases, upon prior authorization by the County Department of Social Services in an individual's/family's home county, Johnson County Social Services may render financial assistance and bill the home county for the amount of such assistance (Code of Iowa: 252:24). This pertains to Iowa residents only. In most cases, the home county is willing to render assistance only if the family/individual is known to them as low-income. The only other major source of assistance for these people is the Crisis Center. People in Iowa City in Connection with the University It is likely that a number of transients in the Iowa City area are attracted here by the University. These people most often stay with friends and don't present a major problem in terms of needs for food, clothing, transportation, and shelter. The need for acute inexpensive medical care for highly contagious diseases (e.g. viral infections, venereal deseases) is the most prevalent need of this group. The Free Medical Clinic is the agency which most often comes in contact with them. 0 0 7. Other Groups of Transients Two other groups of transients are people looking for work and seeking to settle in the area, and people who have a (chronically) transient lifestyle. People in the first group are eligible for assist- ance from Johnson County Social Services if they meet guidelines for financial need and are willing to register for work at Job Service of Iowa. Although a social worker from Social Services is on call 24 hours/day, 7 days/week, direct financial assistance cannot be provided at night and on weekends. The Crisis Center provides assistance from 11 a.m. - 2 a.m. The only source of aid for those in the second group is the Crisis Center. There is no source for assistance to transients between 2 a.m. and 8 a.m. Community Awareness of Need for Services to Transients Residents of Johnson County were asked to rank transients as a group in need of attention in planning for services in the area. Re- sults are based on responses to the Iowa City People's Guide and Survey distributed to Iowa City residents in April, 1977 and on responses from Johnson County residents attending the Johnson County Fair in August, 1977. A total of 2,101 responses were collected. Most of these (2,050) came from Iowa City residents, 32 responses came from other residents of Johnson County, and 19 responses came from people who did not indicate their place of residence. There was no appreciable difference in response according to place of residence. The responses to the survey indicated a low ranking of transients as a priority group in need of planning for services. 897 respondents (42.2%) placed transients fifth of five groups in need of attention. 875 respondent (41.6%) did not reply to this question. • • 8. Only 80 (3.8%) placed transients first in importance. A few respon- dents indicated that they were not aware of a transient problem in Iowa City. TABLE 1 Ranking of Transients as Group in Need of Planning for Services (Iowa City Survey - 1977) Rank Number a of Total 1 80 3.8% 2 95 4.5% 3 75 3.6% 4 89 4.2% 5 897 42.2% No response 895 41.6% TOTAL 2,111 99.90 Statistics on Transient Population The Crisis Center lists the following categories of transients in need of assistance. Numbers and percentages are based on all transient contacts from January thru June of 1977. Transient Contacts Male individuals 316 Female individuals 30 Families/number-in families 30/124 Couples/individuals in couples 29/58 Total contacts 528 The following is information on only those people who received vouchers (food, lodging, or transportation). Reasons for being in Iowa City and Types of Problems Encountered Money stolen on the road 6% While hitchhiking 21 While traveling by car 7 While traveling by bus 2 Total contacts 30 0 0 All cash used for car repairs 93 18% Hitchhiking and ran out of money 27% Traveling (short-term, unspecified destination) 28 Long-term transient traveling with no money 10 Lost money on the road 4 On way home to stay with rela- tives 16 On way to start new job or look for job 25 Unable to get ride due to bad weather 12 On way to pick up check or 49 needing to wait here for check 12 Unable to find day labor along 18 way 25 Person they were to stay with 2 was out of.town 3 Ride left without them 1 Became ill/injured along way 9 Total contacts 145 Moyin to new lace of residence an ran out o money 14% Family member became ill along way 3 Unexpected move due to death in family - no travel money 2 On way to job interview/job 49 Unable to find job - need help getting back home 18 Bus ride cancelled - no money for food or lodging 2 Total contacts 74 In town looking for a job 14% Looking for permanent job 62 Found job but no housing 7 No money until job starts 3 Total contacts 72 a • • Prospective University student - no place to stay 2 .4% Vacationing - ran out of money 1 .2% In town for hospital appointment 9% Veterans' Hospital 21 University Hospitals & Clinics 25 University Hospital 19 Westlawn 3 Oakdale 1 Psychiatric Hospital 2 _ Total contacts 46 No place to stay while visiting some_-_ one in hospital 5% Veterans' Hospital 3 University Hospitals,$ Clinics 25 Mercy Hospital 1 Total contacts 29 Local residents 6% Laid off job - waiting for unemployment check 6 Laid off job because of illness 9 Looking for new job 7 Kicked out of apartment 3 No money for food stamps 5 Total contacts 31 0 0 11. POPULATION SERVED/SERVICES PROVIDED History of Services to Transients (Background Information) The greatest single source of funds for services to transients is funds which have been provided by United Way and administered by the Salvation Army since 1957. These were allocated by the local Salvation Army Service Committee from 1957 to 1973 and by the Iowa City Police Department from 1973 until August, 1975. Since August, 1975 the Iowa City Crisis Center has handled the allocation of Sal- vation Army funds. Wesley Foundation is the only organization which has been a major source of housing for transients. It has been providing this service since October, 1971 and has only recently (August 15, 1977) discontinued the provision of housing to transients. Statistics on Number of Transients Served Figures on the number of transients who have received assis- tance for food, shelter, transportation, and other miscellaneous needs are available from the records of the three agencies which have participated in the allocation of Salvation Army funds over the years. Information on the number of transients housed at Wesley House is also available. Small numbers of transients have been housed and provided with other necessities at local churches. Information on services provided to transients was obtained from 20 churches in Iowa City and Coralville. This information is summarized in Appendix II. The number of Salvation Army vouchers issued in past years is shown in Table 1. Information on the number of individuals served is available only for the last three entries. Caution must be taken in interpreting the figures for years prior to the 12. time when the Cosis Center took over the location of funds. During these earlier years, there was no central location which dealt so extensively in the provision of vouchers and informa- tion/referral as the Crisis Center now does. It seems likely that other resources were more actively providing services to transients in the past. TABLE 1 N of Vouchers to Transients 1957-1977 YEAR FOOD LODGING GAS BUS MISC. TOTAL 1957 34 33 14 20 101 1961 167 42 20 11 240 1970 223 21 68 24 5 341 1971 195 94* 52 6 3 350* 1974 316 253 113 36 8 726(400 persons) 1976 665 558 51** 19** -- 1293(995 contacts) 1977 355 292 57 20 1 724(390 contacts) (Jan -July) 1977 609 501 98 34 2 1244(669 contacts) (extended) * Plus 99 males lodged at jail. **Salvation Army funds for transportation cut off 4/1/76; subsequent funding from Mary F1awtrey Discretionary Fund. As can be seen in Table 1, the number of vouchers given more than doubled between 1957 and 1961 (101 vouchers provided in 1957 and 240 vouchers provided in 1961). This number remained about the same until 1970, when it increased to 341. The additional information on individuals housed at the jail in 1971 adds to the accuracy of the overall picture of the number of transients served. The picture becomes more comprehensive in the 1974 records, with the additional figure for individuals served (400 individuals served in 1974), as well as vouchers provided (726 vouchers provided in 1974). The 1976 and 1977 (January -July) figures are from the Crisis Center records. A total of 995 contacts were made and 1,293 vouchers provided in 1976.: From January thru July of 1977, 390 contacts were made and 724 vouchers 0 0 13. provided. Extended figures for 1977 are based on totals for January thru July, 1977 plus percentages of these based on 1976 data for August thru December. The total number of people to whom lodging was provided at Wesley House includes members of the American Youth Hostel organi- zation and those receiving vouchers from other sources, as well as those receiving Salvation Army vouchers. The number of people who have been lodged at the hostel has shown a steady increase as can be seen in Table 2. TABLE 2 Lodgers at Wesley House 10/71-9/76 Time Period Number of Overnights 10/71-9/72 10/72-9/73 10/73-9/74 10/74-9/75 10/75-9/76 442 1642 1768 2090 (1100 individuals) Of the 1,100 individuals who stayed at Wesley House in the past year, about 400 were AYH members. The remaining 700 were transients who had nowhere else to stay. The average length of stay for both groups in 1976 was two nights. Based on data for the last six months of 1976, the Wesley House staff has determined the following breakdown of those who would and would not be accepted under the policy effective as of August 15, 1977. (Under this policy only AYH members and University students and prospec- tive students are accepted for lodging at Wesley House. AYH mem- berships can be purchased there if the individual wishes and is financially capable. Permanent memberships are $11.00 and tem- porary three -night passes are $1.00 plus $4.00/night charge.) This breakdown is shown in Table 3. . • 14. TABLE 3 Individuals Eligible Under New IVesle House Po on individuals staying from 717 6-12 76 YES NO TOTAL Individuals 310(49%) 334(51%) 653(100%) W of individuals extended to total 176 549 561 1100 Overnights 561(43%) 753(57%) 1314(100%) #.of overnights extended to total 176 899 1191 2090 Sociodemographic Characteristics of Transients Served Information on the sociodemographic characteristics of transients in the Iowa City area has been compiled by the Crisis Center and Wesley House. The Crisis Center keeps records of the following characteristics of the transients seen there: 1) age, 2) sex, 3) travelling companionship (whether the indi- vidual is travelling alone, in couple, or with family). Informa- tion for 1976 and 1977 is shown in Table 4. Wesley House has records of the following characteristics of overnight lodgers: 1) sex, 2) age, and 3) residence. Data on age and sex is shown in Table 5 and includes both AYH members and other transients. TABLE 4 Age, Sex, Travelling Companionship of Transients 8/1/76-7/31/77 (Crisis Center) CHARACTERISTIC NUMBER PERCENT OF TOTAL Total Contacts 1,039 100 PEOPLE SERVED Male Individuals 549 52.8 Female Individuals 68 6.5 Families/H in families 95/330 31.8 Individuals in couple 92 8.9 AGE Under 18 years 177 17 18-35 years 592 57 36-50 years 166 16 51-65 years 94 9 over 65 years 10 1 0 • 15. As can be seen from Table 4, about one-half of all Crisis Center transient contacts in the past year were male individuals (52.8%). About one-third were families (31.8%). Individual females (6.5%) and couples (8.9%) comprised a minority of those who contacted the Crisis Center. In addition, a majority of contacts were with people 18-35 years of age (57%). About one-sixth were under 18 years of age (17%) and one-sixth (16%) were between 35 and 50 years of age. Only one-tenth of all con- tacts were over 50 years old. Although the two populations served by the Crisis Center and Wesley House are not identical, the numbers served are roughly the same. From August 1, 1976 thru July 31, 1977, 1,039 indi- viduals were served by the Crisis Center. From October 1, 1975 thru September 30, 1976 about 1,100 individuals stayed an average of two nights each at Wesley House. Keeping this in mind, Wesley House data for fiscal 1976 (Table 5) indicates a smaller num- ber of under 18-year-olds (about 88) than were seen by the Cri- sis Center (177) during a comparable period. This is largely a result of the fact that Wesley House cannot lodge minors who are not accompanied by a parent or legal guardian, while the Crisis Center deals with all transients, regardless of age. It is also likely that most families are in need of aid for transportation home (mondy for gas), rather than lodging in the area. Transportation assistance can usually be provided to a family at a lower cost than can lodging. It appears also that the proportion of males at Wesley House (68.3%) is greater than that at the Crisis Center (52.8%). However, it is difficult to draw a definite conclusion from this since the data is arranged differently by each agency. • • . 16. Breakdown of the residence of hostelers at Wesley House during fiscal 1976 is not available. A breakdown of residence has been obtained for fiscal 1975 and is shown in Table 6. It is assumed that percentages for fiscal 1976 are roughly the same as those for fiscal 1975 since the percentage breakdowns for age and sex of hostelers in these two years are similar. TABLE 5 Age, Sex of Overnighters at Wesley House 10/l/75-9/30/76 CATEGORY NUMBER PERCENT OF TOTAL Total Overnights 2,090 100 AGE AGE Under 18 years 168 8 Over 18 years 1,922 92 SEX SEX Male 1,428 68.3 Female 662 31.7 Data on residence is included in Table 6. TABLE 6 Age, Sex, Residence of Overnighters at Wesley House 10/1/74-9/30/75 CATEGORY NUMBER PERCENT OF TOTAL Total Overnights 1,768 100 AGE Over 18 years 1,958 90.4 Under 18 years 170 9.6 SEX Male 1,362 77 Female 406 23 RESIDENCE Iowa 576 32.6 Out-of-state 1,192 67.4 Adjacent States* 468 26.5 Other states 644 36.4 Foreign countries 80 4.5 *Ill., Mo., Kan., Neb., S. Dak., Minn., Wis. • 17. As can be seen from Table 6, about one-third (32.6 percent) of those overnighting at Wesley House were Iowa residents. An additional 26.5 percent reside in the states adjacent to Iowa. Of the hostelers during this time, 36.4 percent living in other U.S. states and 4.5 percent from foreign countries. Data on income is not obtained by either the Crisis Center or Wesley House. The Crisis Center estimates that most clients earn far below $9,999 per year. As previously mentioned, 75 (14 percent) of the 526 Crisis Center contacts from January through July of 1977 were in the Iowa City area in connection with one of the hospitals. No information is maintained by the hospitals on the patient population which is without resources to provide for basic necessities while in the area. It would be difficult to keep statistics on those who are ineligible for assistance through established channels (e.g., State papers County clinical papers), as there is no means to follow up on their circumstances. General information on characteristics of the overall patient titi tal populations at University Hospitals and Clinics and VA Ho spl and during the last fiscal year for each is given in App end 2, This information is discussed briefly below. As ais of limited s value in describing the population which has need of assistance from community soul at great length. ces, it will not be dealt wit University of Iowa Hospitals and Clinics served 39,241 inpatients ents during fiscal 1977 (July 1, 1976 through and 309,693 outpati June 30, 1977). Of the total inpatients served11,408 inpatients , (29 percent of all inpatients) and 41,574 outpatients (13 percont of all outpatients) were indigent (eligible for services provided through State papers and therefore not in need of community assis- 0 0 18. tante). Those individuals in need of assistance might belong to any of the three remaining categories, as described and defined in Appendix 1. VA Hospital served 7,607 outpatients and 9,228 inpatients during fiscal 1976 (October 1, 1975 through September 30, 1976). About 1.5 to 2 percent of these were Johnson County residents (114-152 outpatients and 138-185 inpatients). The great majority of those treated are out -of -county residents. Patients must meet financial guidelines to receive transportation aid, but no informa- tion is available on income levels of patients. There is no record of the number of patients given assistance through community re- sources. Other demographic data is presented in Appendix 2. Associated Needs of Transients While the basic needs of transients are those discussed above (food, shelter, and transportation), other assistance is sometimes required. The need for medical care is one of these. The Free Medical Clinic is the major source of medical care for transients who have a need for immediate care of a non -emergency nature. Although the Free Medical Clinic does not keep records on the tran- sient population served, information on residence in maintained and gives an indication of the extent to which transients use service there. A total of 520 patient visits were made by out -of -county patients in 1976. The number of visits by Johnson County residents and non-residents is shown in Table 7. 0 0 19. TABLE 7 Patient Distribution for 1976 (Free Medical Clinic) PATIENT DISTRIBUTION MALE FEMALE TOTAL Johnson County Residents 1,182 2,521 3,703 Out -of -County 170 350 520 TOTAL PATIENT VISITS 1,352 21871 4,223 TOTAL INDIVIDUALS SERVED = 2,886 A second associated need of transients is that for counseling. There are essentially two types of counseling which are provided to transients in Johnson County: 1) short-term counseling designed to alleviate an immediate crisis situation, and 2) longer-term counseling aimed at mitigation of problems which are more deeply rooted in the individual's lifestyle. Counseling is provided in Iowa City by the Crisis Center and was also provided in.the past by Wesley House. Counseling provided is primarily of the first type, due to the limited stay of most transients. Referral to appropriate resources for longer-term counseling is made when necessary. Referrals to Other Sources of Assistance to Transients The following agencies/organizations which deal with transients in the area list these referral sources as those most often con- tacted: AGENCY REFERRALS RECEIVED FROM REFERRALS MADE TO 1) Crisis Center J.C. Social Services Wesley House (lodging) Wesley House John's Grocery (food) Local ministers Dividend Gas (gas) Iowa City Police Union Bus Depot (bus ticket) Coralville Police J.C. Social Services (finan- cial assistance for residents) 0 AGENCY REFERRALS RECEIVED FROM 0 20. REFERRALS MADE TO 2) J.C. Commission on J.C. Social Services J.C. Social Services Food Veteran Affairs Stamp Program (for those seeking to establish residence) State Papers Program (for hospital bills over quota) 3) Sedaven House University Hospitals None (no longer in Crisis Center operation) 4) Stone Soup Cooperative Crisis Center None Restaurant Wesley House 5) University Hospitals Dept. of Social Serv. Dept. of Social Services Social Service Dept. (financial assistance) Wesley Foundation (lodging) Campus Ministries Crisis Center (financial aid for various types of assist- ance) 6) VA Hospital Private Physicians Dept. of Social Services Social Work Service Private Hospitals (financial assistance) Dept. of Soc. Services Veterans' organizations 7) Wesley House Crisis Center Crisis Center (vouchers) (no longer pro- Commission on Veteran J.C. Social Services (finan- viding•services Affairs tial assistance for residents) to transients) Local churches Commission on Veterans Affairs University Hospitals (financial assistance) Psych Hospital Oakdale VA Hospital MECCA Univ. and VA Hospitals Free Medical Clinic Stone Soup (meals) Free Store (clothing) 8) Free Store Wesley House Wesley House (temporary housing, employment) Crisis Center (temporary housing) Job Service of Iowa (temporary employment) Stone Soup (meals) 9) Free Medical Clinic Wesley House University Hospitals (more Crisis Center specialized care) 10) Local Ministers University Hospitals Wesley House Oakdale Crisis Center J.C. Social Services Free Medical Clinic J.C. Social Services Iowa Memorial Union (housing) 0 r 21 UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY Lodging Wesley House provided lodging to approximately 600 individuals in 1976 who would not qualify under the policy established August 1s, 1977.1 This means that about 50 persons per month will have to find other provisions. In addition, Sedaven House is no longer providing lodging to patients at University Hospitals. Approximately 40 in- dividuals per year were housed there. These figures indicate that about 650 transients per year, who were previously provided lodging will no longer find such lodging to be available. The Crisis Center is now referring transients for lodging to five rooming houses and motels whith charge reasonable rates ($5.50 - $13-00). These rates, however reasonable, represent a substantial in- crease over the $4.50 per person per night cost at Wesley House, $2.50 of which was subsidized by the United Methodist Church and $2.00 provided through Salvation Army funds. The Salvation Army temporarily increased the amount of funds for lodging and food vouchers from $200/month to $400/month as of August 15, 1977. This will help meet the cost of needed services although it is not certain how long increased funding will be available. The main problem is the lack of places for transients to stay. The only additional resource beside the rooming houses and motels men- tioned above for lodging referrals is the Coralville Reservoir where camping is available during the warmer months. Tent rentals are $20/week and $15/weekend. This cost represents a moderate to substantial in- crease, depending upon the length of stay and could not be reccommended to all transients (e.g., people with health problems). The Iowa City jail, previously mentioned as a possible source of lodging, is not pre- sently available. The Johnson County jail may be used as a last resort for lodging of individual males and females when space is available. The following additional needs for lodging services for tran- sients have been indicated through questionnaire responses by and meet- ing with agencies. The agencies which have specifically mentioned these appear in parentheses. 1. Refer to page 13 for explanation of Wesley House policy. • 22. 1. Need for emergency housing for families, late-night arrivals, victims of spouse abuse, persons trying to relocate in Iowa City (Crisis Center). `L. Need for longer-term emergency housing than the two or three days previously available at Wesley House (U of I Special Support Services, Wesley House, various churches --although Wesley House's plicy has recently changed, this need should still be mentioned). 3. Need for more extensive lodging provisions for attending re- latvies/friends of hospital patients and in some cases, out- patients: a) There are no lodging provisions for companions of ante- partum patients at University Hospitals, b) There are no provisions for relatives of patients at the VA Hospital, c) The demand for lodging has exceeded the supply at Sedaven House (since lodging there is no longer available, the only source specifically earmarked for hospital visitors is United Ministries in Higher Education which has only two or three beds). 4. Need for more housing for transients (DSS, police, various churches). This is a growing concern, especially now that Wesley House has changed its policy and Sedaven House is no longer in operation and the facility is being sold. S. Need for lodging provisions (halfway house) for males who are former -patients of mental institutions (Wesley House) and for those individuals on pre-trial release (Court Ser- vices). Transportation Funds for transportation assistance were supplied by the Salvation Army prior to April 1, 1976. Since April, 1976, funds for the pro- vision of transportation assistance have come for a special fund set up by the Crisis Center and supported by donations from local churches and individuals. The Mary Hawtrey Discretionary Fund, as it is called, supplies all funds for transportation assistance to transients. The assistance which can be provided with these funds is minimal amounting to about $25.00 per month. • • 23. There are no provisions available for car repairs, which are necessary when a family's car breaks down in the vicinity and they do not have sufficient funds to have it repaired and continue on their way. Free car repairs and towing services have been pro- vided to families in need in the past by several garages. This is no longer being done, due presumably to rising price, abuse of ser- vices, or both. Free towing service is presently provided for a- bandoned or broken-down cars only when an emergency situation exists (e.g., car breaks down in traffic lane, on Interstate 80). Transportation by state car is available to patients at Uni- versity Hospitals with.state papers and their escorts (one escort per patient, determination of need for escort made according to guidelines). Those patients without state papers may use state car at their own expense. Authorized patients at VA Hospital are eligible to receive transportation assistance. VA Hospital is not authorized to give assistance to attending friends or relatives. The Commission of Veteran Affairs in the patient's home community makes provisions for assistance to a friend or relative according to its policy on determination of need. VA Hospital makes referrals for transportation assistance and assistance of other kinds to the Commission in a patient's home community when necessary. Problems arise when a patient at University Hospitals does not qualify for state papers and does not possess sufficient funds to pay for transportation costs. There is also a problem when a patient with- out funds needs an attendant for psychological or other support but does not qualify for escort provision. This second problem applies also to patients at VA Hospital. The following needs for transportation assistance have been in- dicated. Again, the agencies who mentioned the needs appear in par- entheses. 1. Lack of sufficient funds for transportation assistance, especially since the Salvation Army cut off funds for this purpose (Crisis Center, Wesley House). 0 24. 2. Some problem with sufficient space for inpatient parking and inability of some inpatients to pay for parking (VA Hospital, University Hospitals and Clinics). Employment The principal need in employment is for a "spot -labor" arrange- ment so that transient persons in the area may "earn their keep" while here and earn enough money to enable them to continue to their destin- ation. No definite program exists at the present time. Job Service of Iowa does have day labor available occasionally although not on a completely reliable basis. Wesley House has offered some spot -jobs to transients in the past, in exchange for lodging. Stone Soup provides a free meal in exchange for a couple of hours work there. Six out of the 20 churches in the area who responded to a survey in June, 1977, provide odd jobs in exchange for assistance. These provisions can only be extended to a small number of people since the resources of individ- uals churches are limited. this also does not constitute a day labor program, since it allows individuals to "earn their keep" but does not provide for travel to their intended destination. During June, 1977, a pilot project on day labor was conducted by LINK in cooperation with Job Service of Iowa, Iowa City. The two agencies were attempting to determine whether a program for the provision of labor could be set up in the area. The project failed due largely to an inability to match applicants with available jobs. A problem in providing suitable short-term jobs exists in that many of the jobs available in the past have been taken over by other programs, such as chore services to the elderly, and are no longer available to transients. The need for increased provision of spot -jobs has been indicated by the Crisis Center, Wesley House, Iowa City Police Department, and several local churches. A substantial number of the transients with whom the Police Dept. comes in contact with would like to find short- term job opportunities. Lack of a specific place where transients can congregate to wait for phone calls regarding employment has been men- tioned by Job Service as a problem. • 2s. Food/Clothing Food is provided to transient persons in need through Salvation Army vouchers for $2.00 per person to John's Grocery (via the Crisis Center) and in exchange for work at Stone Soup Restaurant (except when Center East is closed for three weeks of the year.) Eight out of 20 local churches surveyed provide food to a small number of transients and six of them provide financial assistance for procure- ment of food. Free clothing is available from the Free Store (when Center East is open). Inexpensive clothing is available from Goodwill and the Salvation Army, as well as from a couple of private clothing stores in Iowa City. Three of the 20 churches surveyed have provided clothing and one has provided financial assistance for clothing to a small number of transients. No greater need for the provision of clothing has been indicated. Other Concerns/General Needs for Services to Transients The following general concerns and needs have been indicated by agencies: 1. Insufficient community funds for transients --too low a priority in community (Crisis Center, U. of I. Special Support Services; the inadequacy of existing services for transients was mentioned often) . The limits on amount ($200/month) and use (lodging/food only) of Salvation Army funds have been specifically mentioned as a prob- lem by the Crisis Center and Wesley House. 2. Need for consistent interagency policy; lack of communication among agencies (Salvation Army, Crisis Center, various churches; this was also brought out in the meeting with VA Hospital staff in that patients sometimes do not understand the circumstances under which the Hospital does/does not provide lodging/meals to patients). 3. Need for greater publicity of services (Crisis Center, various churches). 4. Need for better counseling for transients (Crisis Center mentions that it is sometimes difficult for volunteer professionals to relate to clients' needs/problems; mentioned also by several CXhurches). 0 S 26. 5. Some concern about attracting more transients through provision of "free" services (has come up in discussion a few times). 6. Difficulty in making services accessible after business hours (mentioned by a couple of churches). 7. Need for more services to out -of -area hospital patients and those attending them. 8. Need for greater understanding of the policies of public hospitals on the part of the surrounding community (VA Hospital, University Hospitals). A number of these needs concern the inadequacy of presently available resources for the provision of services. Thirteen of the 20 churches surveyed indicated that services for transients are inadequate. It should be noted that all of these concerns were expressed prior to the announcement of the change in policy at Wesley House. The need for a consistent interagency policy should be particulary stressed. There is also a need for the development of a definite policy on the provision of aid to transients on the part of the community as a whole. Trends in Delivery of Services to Transients The following trends, or changing patterns, which are re- lated to the delivery of services to transients are apparent: 1. The number of transients in the Iowa City area has shown a steady increase in recent years. 2. The number of transients in the area is highest during the late summer and autumn months and lowest during the winter months. Number of Transients Receiving Salvation Army Vouchers July, 1976 -June, 1977 July -October, 1976 325 November 176 -February, 177 145 March -June, 1977 258 TOTAL SERVED: 0 0 27. 3. The number of transients requesting lodging and other assistance at the Iowa City jail has tapered off in the past few years. It has been suggested that this is due to the change in administration of Salvation Army funds from the Police Department to the Crisis Center and the extent of lodging provided by Wesley House. 4. The number of transients without a place to stay will in- crease greatly now that Wesley House is no longer offering lodging to the general transient population. Approximately 600 persons per year will need another source of lodging. • • 28. APPENDIX 1 Patients Served - University of Iowa Hospitals and Clinics July 1, 1976 - June 30, 1977 A• University Hospital Admissions Pay Class Number Percent of Total Indigent 11,408 29 County Clinic Pay* 232 .6 Clinical Pay** 5,786 14 Private Pay 21,815 55 TOTAL 39,241 98.6 B. University Clinic Outpatients Pay Class Number Percent of Total Indigent 41,574 13 County Clinic Pay* 4,562 1.5 Clinical Pay** 78,719 25 Private Pay 184,838 59 TOTAL 309,693 98.5 * County Clinic Pay - covers hospital costs and cost of physician's services **Clinical Pay - physician's services provided at reduced cost to patient • + 29. APPENDIX 2 Age_ Sex Residence of VA Hospital Patients October 1, 1975 - September 30, 1976 Category Number Percent of Total SEX Male 16,734 99.4 Female 101 .6 AGE Under 45 years 3,535 21 45-64 years 9,428 56 65 and over 3,872 23 RESIDENCE (estimate) Johnson County 252-337 98-98.5 Other 16,498-14,583 1.5-2.0 PATIENT STATUS Outpatient 7,607 45.2 Inpatient 9228 54.8 TOTAL PATIENTS 16,835 100 AGENCY Iowa City Crisis Center Johnson County Commission of Veteran Affairs Iowa City Free Medical Clinic Free Store APPEND: AGENCIES WHICH PROVIDE : SERVICES PROVIDED Salvation Army vouchers and referral for food, lodging. Vouchers for gas, bus tickets; short-term crisis counseling services available at office from 11 a.m. to 2 a.m. 7 days and week and by phone 24 hours/day. 995 transients served in 1976: 558 lodging vouchers, 665 food vouchers, 51 gas vouchers, and 19 bus vouchers. year). Em( Cr: tei , bus, fti: es lv 6 to 0 AGENCY Sedaven House (no longer in operation) Stone Soup Restaurant University Hospitals and. Clinics - Social Service Department Veterans' Administration Hospital - Social Work Service Fc PE Ha ti 19 Pr wi fo 7i 5� 7 ad RETAKE OF PRECEDING DOCUMENT JORM MICROLAB TARGET SERIES SO 0 M M N 41 W qP NP dP dP M Ln a) 0 O c°�N N ro v~j to H •H rl VI O O O ?•. N 0 oo N .� O U W d O C rl ° Et 0 'cl N ro> ro •H Ca F ro "Cl N V) C ro 7 H H C ro ro r 7 C •H 0 H A .- cd O O Cd 4j o N O C H O) w J.~ �-I F+ d .moi U rH-I �I N I..) 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VI w •.H O 41 �" O u is bo vi d 4,w w b +J 4-4 y•0 0 °°v N4 LL °'� b �HcipHV)°r-a) alfo�•o ai Uc H�q4j=OXuptU�� .20s" o +N b N H 1-q C U i1 y N N •.� rl N 4+ N W 0 9 O C O ton 7 r= O •�p� N r1 C d W U N in N x U) V7 W r•I ttf .O1-1� yq K N O O H U P• 0. c�0 �m F V U 4) bo N 9 0 p 00 b0U C En N N •� O m Ou vyU 0 4'4+ Ln Ln ami G -Hth y - X N b U r 4+ y>�� s • 0 HUMAN SERVICES STUDY JUVENILE JUSTICE PROFILE October 7, 1977 Justice Sub -Committee Members: Rex Honey - Chairman Doris Bridgeman Mary Boland Mardi Cooper Roger Darnell Carol Spaziani Staff: Connie Echternach _ Mary McCue Naomi Miller Larry Allen u , Johnson County Regional Planning Commission ` 22h South Dubuque Street Iowa City, Iowa 0 s TABLE OF CONTENTS Juvenile Delinquency Prevention and Intervention GOAL . . . . . . . . . . . . . . . . . . . . . . SERVICE AREA DESCRIPTION . . . . . . . . . . . . Service elementsJ. . . . . . . . . . . . . . . PROBLEM DESCRIPTION 1 1 Family stability . . . . . . . . . . . . . . . . . 2 Families with service needs . . . . . . . . . . . . . . . . . 5 - Endangered children . . . . . . . . . . . . . . . . . . . . . 5 Delinquency prevention . . . . . . . . . . . . . . . . . . . 5 Diversion . . . . . . . . . . . . . . . . . . 5 Least coercive disposition . . . . . . . . . . . . . . 6 The violent and/or repeated delinquent . . . . . . . . . . . 6 ` Coordination among agencies . . . . . . . . . . . . . . . . . 6 Resource allocation . . . . . . . . . . . . . . . . . . . . . 6 POPULATION SERVED . . . . . . . . . . . . . . . . . . . 7 Statistics on number of juveniles in Johnson County. . . . . 7 Complaints . . . . . . . . . . . . . . . . . . . . . . . . . 7 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . . . 8 , Entry.into the juvenile justice system . . . . . . . . . . . 8 Types of service intervention . . . . . . . . . . . . . . . . 11 Funding . . . . . . . . . . . . . . . . . . . . . . . . . 13 UNMET NEEDS . . . . . . . . . . . . . . . . . . . . . . . . 15 Outreach . . . . . . 15 Substance abuse. . . 15 Information -referral . . . . . . . . . . . . . 16 Education. . . . . . . . . . . . . . . 16 Detention facilities . . . . . . . . . . . . . . . . . . . .. 16 Attorneys . . . . . . . . . . . . . . . . . . . . . . . 16 Handlingof offense. . . . . . . . . . . . . . . . . . . . 17 Coordination of services . . . . . . . . . . . . . . . 17 Alternative recreation opportunities . . . . . . . . . . . . 17 Vocational training . . . . . . . . . . . . . . . . . . . . 18 Jobs/income guidelines . . . . . . . . . . . . . . . . . . . 18 Family interaction . . . . . . . . . . . . . . . . . . . . . 19 APPENDICES APPENDIX 1 Johnson County Juvenile Probation Office - Annual Report for 1976. . . . . . . . . . . . . 20 APPENDIX 2 Information on Agencies . . . . . . . . . . . . . 26 . . 33 38 10-3-77 JUVENILE #INQUENCY PREVENTION AND 1*RVENTIO GOAL The goal is to establish, maintain and improve the programs and services that reduce juvenile delinquency in Johnson County, and redirect delinquent activities into more constructive, self- fulfilling activities. SERVICE AREA DESCRIPTION Juvenile Justice Prevention programs are designed to develop, organize and promote all those activities which are designed as de- terrents from or disincentives to delinquent behavior among children and adolescents. These embrace special programs conducted by local delinquency prevention commissions, neighborhood centers, and simi- lar,groups to work intensively with young people and to keep them occupied with some organized activity. A companion thrust of the program may be to prevent and reduce recidivism by working inten- sively with known juvenile delinquents. Service Elements: Recreation programs for problem children*; out- reach;:advocacy; education on drugs, alcohol, sex and legal rights; family mediation, education, and support; employment services; education; vocational training; protective services; law enforcement (police, sheriff, probation officers, juvenile court, juvenile di- version and juvenile detention); shelter, alternative living situa- tions; and rehabilitation services. PROBLEM DESCRIPTION According to the National Advisory Committee on Criminal Justice Standards and Goals, published in 1976, the number of offenses com- mitted by youthful offenders has been growing at an alarming *Regular recreational activities not specifically designed to prevent juvenile delinquency are excluded from this definition. However, additional or special recreation activity having delinquency preven- tion as its primary objective is included. r M 2. rate. From 1960 to 1974, arrests of males and females under 18 years of age have increased by more than 140 percent. National polls of citizen concerns have placed crime at or near the top for several years. What is not well known, however, is that a large number of those arrested for felony type (Part 1) offenses are 17 years of age and under. In 1974, juveniles accounted for almost one-third of Part 1 arrests nationwide. In cities, they accounted for 'almost one-half of such arrests.I Even larger numbers are involved with the juvenile justice system as a result of lesser acts of the neglect and abuse of their caretakers. Table 1 is a representation of the 1974 felony -type crimes committed,by juveniles aged 17 years and younger. Table 2 is a representation of the juvenile male and female arrest trends, and the percent change from 1960 to 1974 for all arrests, violent; crimes, and felony type offenses. The following abbreviated major themes identified by the Juvenile Justice and Delinquency Prevention Task Force are considered central to ,,.any discussion on juvenile delinquency and must be focal points for communities involved if effective work with juvenile delinquents is to be accomplished. They are. 1. Famil stabil. It is strongly urged that a major concerte e� ort be made to strengthen the family en- vironments in which children develop if reduction in delinquency is to be achieved. iJuvenile Justice and Delinquency Prevention Report of the Task Force on Juvenile Justice and Delinquency Prevention (1976), p. 2Ibid, p. 2 TABLE 1 0 PERCENT 71794 ARRESTS REPRESENTED BY JUVENILES >a 17 and @am . . Index o££_e(rlonrType Crime) 100% - S;. »% 2, 7 A a; 45.6 33% _a f! . m ..........�,4 A p m q A 17; mApAAA2 % h ° ( ( (1)0 4J ,/ m \ k ° ] ) ' §\ | R ] a / j/ /j §, cu R ) §\ i� § § (Percent 400 350 300 250 200 150 100 ARREST TRENDS - PERCENT OF CHkN-GES 1960-1974 N d d d N N N N 18 & Over Under 18 I All Part 1 N rl a NCd ILI 18 $ Over Under 18 18 & Over Under 18 S. 2. Families with service needs. It is urged that the use of vague criteria use to gain jurisdiction over non -criminal juvenile misbehavior be discontinued. Only conduct that is clearly defined and clearly harmful to the child and fam- ily should be subject to family court jurisdiction under the families with service needs concept. 3. Bndan Bred children. It is recognized that the declared aim o prese�It policies of coercive state intervention on be- half of endangered children is to provide such children with permanent, stable family homes. Although this objective is supported, it is believed that current practices of exten- sive state intrusion in family affairs strongly contradicts the long -held societal values of family autonomy and privacy. By limiting coercive intervention cases where specific harms to a child have been identified, the state can insure that intervention will take place only when it will be likely to improve the childs situation. 4. Delinquency prevention. It is believed that no issue is of greater import in the field of juvenile justice than the prevention of delinquency. It seems clear that efforts aimed at the early delivery of services to young people who may be headed for careers of crime have more promise as a method of reducing crime than attempts to control delin- quency solely by strengthening various components of what - is normally considered juvenile justice. S. Diversion. It remains as an underlying principle that juve- niles s ould be subject to no more contact with the system than necessary. Many of the juveniles who are brought to the attention of the justice system officials are clearly in need of rehabilitation and/or some type of supervision. But, for a substantial portion of this group, the full coercive power of the court is unnecessary to deal with juvenile problems. There are at least three principles that should guide the operation of all diversion area practices in the juvenile justice system. First, diversion should not be offered un- less there is some effective service for treatment in which the juvenile may participate. Second, expansion of diver- sionary programs should not increase .the total number of juveniles that are under some type of supervision of juvenile justice system. Finally, candidates for diversion should be guaranteed the same due process rights as juveniles who are processed formally within the juvenile justice system. 0 6. 6. Least coercive dis osition. It is urged that juveniles be institutionalize only as a last resort. There seems to be little doubt that the most coercive dispositional alterna- tives are more expensive and time consuming. Moreover, high levels of coercion may breed contempt and hostility, which fosters anti -legal attitudes among the youth. 7. The violent and/or re Bated delin uent. Evidence indicates Mat a large num er o juveniles appear to be chronic law violators. There would seem to be every indication that a small segment of the juvenile population is responsible for a highly disproportionate number of the delinquent acts committed by juveniles. The juvenile justice system is, at present, not adequately equipped to deal with the growing tide of youthful violence or with the violent or repeated offender. Coordination among agencies. It has become clear that the institutions that have traditionally been_' thought to make up the juvenile justice system - the police, courts, and corrections - often work at cross-purposes in that it is difficult to either combine operations as constituting the true system. It is believed that juvenile justice will continue to operate in a fragmented fashion until some con- sistent policies are established. Resource allocation. Although it is recognized that many states and local communities simply do not possess suffi- cient resources to elevate their juvenile justice systems to an ideal level of operation, states must begin to provide solutions to the thoroughly neglected problems of juvenile justice systems. Existing resources must be reallocated to reflect more fully the seriousness of the problems of the youth in this society. • • 7, POPULATION SERVED In 1970, the 0-19 age group comprised 37 percent of the Johnson County population (26,399) while in 1974 this age group com- prised 33 percent of the total Johnson County population (25,367). The 10-19 age group in 1970 comprised 29 percent of the population total (14,078) and in 1974 this age group comprised 20 percent of the total population (15,105). From 1970 to 1974, the 0-19 year old population in Johnson County declined by 4 percent; from 1970 to 1974 the 10-19 year old population in Johnson County increased by 7 percent. Complaints: The number of complaints against juveniles in Johnson County which were reported to the juvenile probation office increased from 550 in 1971 to 804 in 1976, a 46% increase during the five-year period. Of the 804 complaints reported in 1976, 587 (73 percent) were acted upon by the court.* An additional 217 cases were filed with- out action. Of the 587 acted upon, 461 (78.5%) were delinquency cases; the other 126 (21.5%) cases were children in need of assis- tance. The list of offenses appears in Appendix I. Eleven cases were dismissed as not being provable. Of the 461 charged as delin- quent, 107 males and 10 females had multiple referrals during 1976. Thirty-five males and three females had five or more previous con- tacts with probation. The 804 complaints against juveniles in Johnson County do not include those who were warned, taken home, or otherwise diverted without a complaint being recorded. *Definition of "acted upon" is found in Appendix I. go The Iowa City "Peoples Guide and Survey" was examined to see how much concern was expressed for juvenile problems by the respon- dents. To the question of whether more attention needs to be given to delinquency prevention, the following was noted: Percent Response 21.1 Definitely 39.2 Probably 16.4 No Opinion 7.7 Probably Not 6.8 No Response The percentage who felt this area should definitely receive more attention was exceeded only by those wanting to give more attention to information and referral, problems of the elderly living alone, and daycare for the elderly. In a ranking of age groups who need to be given more attention and services, 13.7 percent ranked the junior/ senior high group as most important, 18.9 percent ranked them as second in importance, and 32 percent did not rank them at all. SERVICES PROVIDED A juvenile can enter the juvenile justice system in various ways: through complaints from neighbors, passers-by, and other un- official sources; through direct complaints from institutions and agencies; through complaints from parents; through the child, him- self, requesting assistance; and through actual law violations. The various means by which the child enters the juvenile justice system are discussed below. Complaints received from neighbors, passers-by or other un- official sources are channelled to various agencies, primarily the Department of Social Services, Johnson County Sheriff's office, 0 i 9. Iowa City and Coralville Police Departments, and the Probation Office. School systems normally report children who are truant or who have behavior problems. Recreation agencies may also re- port seriously disruptive behavior. Their complaints usually go either to the Probation Office or to the Department of Social Services. Complaints from parents normally focus on one of two areas: children who are incorrigible (i.e., staying out too late, not following rules at home, not doing chores, involved in sub- stance abuse) or children who run away. Such complaints may go to the police, sheriff, Probation Office, or Department of Social Services. The child himself can file a petition to be removed from his parents' custody or to have his home situation examined by officials. The child can describe the situation to social service or probation officials, and they in turn can bring the case to the attention of the court or, if possible, work with the case outside of court pro ` ceedings A child can also enter the juvenile justice system through -actual law violations (that is, those violations for which adults can be arrested and prosecuted). Some of these violations are: petty theft, burglaries, assault, and breaking and entering. Normally, the first time a child is arrested or is exhibiting atypical behav ior, (e.g., being incoherent from drug usage), the arresting officer may release him and speak with his parents. It is also possible under these circumstances that he/she may be referred to the juvenile court to be placed on "informal adjustment/probation". Children who are chronic offenders and/or children in whose cases other variables intervene in a contributory manner to breaking 10. the law (e.g., family problems, drugs, etc.) are normally handled differently. The child, after being picked up or having turned him- self/herself over to authorities, can be released to his/her parents at which time the police secure a "promise to appear" order from them. In some cases, if circumstances warrant, an emergency order is given by the juvenile court judge for temporary custody of the child to be transferred to the courts and the child placed in an appropriate alternative living situation. This placement is made by referring the case to the Department of Social Services. The Department of Social Services may also become involved without making an out -of -the -home placement. Whether the child is returned home or placed in an alternative living situation, the Juvenile Probation Office refers the case to the Assistant County Attorney (in juve- n.ile matters) for the filing of a petition and the setting of a date for a juvenile court hearing. z The juvenile court hearing involves two phases: an adjudica- tory phase in which the judge makes a ruling on the allegations in the petition and a dispositional phase in which the judge decides upon the most appropriate placement for the child. The judge's rulings are based upon the following: social histories and plans submitted to the court by the Probation Office and/or the Department of Social Services, other court -requested records.or reports, and testimony by various requested witnesses. The following rulings are possible: dismissal, continuance (informal probation) with a hearing set for a later date, adjudica- tion of Child in Need of Assistance (CINA), an adjudication of delinquency, and transfer of the case to adult court. 11. In cases where the child is adjudicated CINA, the dispositions can range from placement and treatment in the natural home to place- ment in a residential treatment center. In cases with adjudication of delinquency, possible dispositions range from probation in the community to placement in a state training school. See Appendix'III for further elaboration on placement possibilities. of Service Intervention When the child's law violations, status offenses, and/or accompanying interpersonal, family, and community problems warrant the intervention of the Probation Office, the Department of Social Ser- vices, and/or the Juvenile Court, efforts are geared toward the mobilization of existing community resources so that the "least coercive" intervention will be utilized in hopes of alleviating or mitigating the youth's problems so that he/she can function in a more normal and rewarding way within the community. Appendix IV describes the alternative interventions. The primary thrust of these efforts is to keep the child in his/her natural home. Doing this may require the use of counseling services provided by individuals or agencies in Johnson County such as the Probation Office, Department of Social Services, Families, Inc., Lutheran Social Services, Owen Duffy, psychologist, the Child Develop- ment Clinic, Research and Training Clinic, and Psychiatric Hospital. These agencies help to provide avenues for better family and indi- vidual functioning within the family unit, neighborhood, and com- munity. They help to clarify potential problem areas by.providing individual, family, group and/or marital counseling. The above- • • 12. mentioned agencies and individuals also use and work with other complementary and supplementary agencies and institutions. If the child is having problems in school, staffings with school personnel to assess the problems and the best mode of inter- vention can be arranged. First, efforts to accommodate the child in the existing structure and curriculum are attempted (such as changing or dropping classes, changing instructors, coordination between school and parents). If this fails, efforts are geared toward a change in the curriculum, school, and/or structure. Possible alternatives include the Resource Action Program (RAP), the Community Experimental Education Center (CEEC), and involvement with Grant Wood Area Education Agency so that the institutions adapt more easily to the child's needs. Forcing the child to fit the expected mold of the institution, would, in most cases, further antagonize the situation. z If the child desires to work, possibilities for employment should be explored. Job Service of Iowa, (for children 16 and over) Summer CETA, RESB, and the Governor's Youth Opportunity Program (GYOP) are potential employment possibilities for youth. The Sum- mer CETA program and the GYOP program are many times shackled by strict income guidelines, which are sometimes an impediment to ..obtaining jobs for young people. Encouragement of active participation in some form of recrea- tion is normally given. The Iowa City Recreation Center, University of Iowa Fieldhouse, activities offered by United Action for Youth, Hawkeye Area Community Action program -sponsored activities, and 13. various other activities are available for entertainment and serve to divert and channel youth activities into other areas of interest. The physical health of young people is also an area of concern. Youths who have health questions and/or symptoms or injuries or are seeking preventive measures for various health problems can be served by area doctors, Mercy Hospital, University of Iowa Hospitals and Clinics, Emma Goldman Clinic, and the Free Medical Clinic. The Free Medical Clinic is particularly successful in reaching youth who, due to circumstances which they prefer to keep confidential (such as birth control information and devices, check-up and treatment for venereal disease, and pregnancy tests) normally would not seek help. Some of the above-mentioned services provided for juveniles become more accessible if the custody of the child is placed with the court (initially) or the Department of Social Services (after ' adjudication). For example, the eligibility guidelines for the summer CETA and the GYOP programs are waived when the custody of a juvenile is with the court or the Department of Social Services. Also, there is now a more intensified effort to fill the slots in alternative school systems (e.g., PS4, CEEC, and the RAP program) with youth whose custody resides with the court or the Department of Social Services. Funding Juvenile delinquency prevention has received a lot of atten- tion in the community during the past 10 years. LEAA funds have been allocated for such projects as juvenile officers for both L4. Coralville and Johnson County, training for juvenile officers, boys' and girls' group homes, United Action for Youth, and a drug film for school use. Currently LEAA is funding a planning process for a juvenile diversion project. In addition, funds from the City have been used to support youth services such as the Mayor's Youth Program, the Youth Newsletter, PALS Program, United Action for Youth, the Police Explorer Post, and a youth services coordi- nator at the Department of Social Services (this position is now defunct). Currently, for fiscal year 1978, the Mayor's Youth Program, PALS, UAY, and Youth Homes, Inc. have received agency funding amounting to a total of $60,775: The following is the funding breakdown: I. Mayor's Youth Program $20,955 34.5% 2. PALS 7,260 12.0% 3. UAY 24,560 40.5% ' 4. Youth Homes, Inc. Youth Emergency Shelter 8,000 13,0% TOTAL $60,775 100:0% United Way at one time was providing funding for Mayor's Youth.and United Action for Youth. Although both are still con- sidered member agencies, United Way's current funding involvement with youth agencies is primarily with the Boy Scouts and Campfire Girls. However, a number of United Way agencies such as the Free Medical Clinic, Iowa Children's and Family Services, Lutheran So - tial Service; Mark IV, and Crisis Center devote considerable re- sources to serving youth. 0 0 JUVENILE JUSTICE UNMET NEEDS The following concerns surfaced in our probing of the juve- nile services as areas of concern: is 1) There seems to be considerable agreement that "outreach" and/or contact with trusted adults who can serve as friends and role models is one of the most important resources in delinquency prevention. This resource is in need of expansion. 2) Substance abuse, particularly alcohol, among juveniles is of great concern; this is one of the problems re- ported on the school questionnaire as increasing. Many agency representatives, especially the law enforcement personnel, expressed the need to have a drug and alcohol counselor, trained and effective in working with young people in the Johnson County community. Both Reality X and MECCA also see this as a need although they have not been able to fund such a service. MECCA at present is •developing a counseling program relative to alcohol and - drug abuse. This program is contingent upon funding. Concern was also expressed about inappropriate placement of adolescents in jail with suspected or verified sub- stance abuse problems. Treatment for emergency service is available at Mercy or University Hospital; however, long-term residential care, although available at Oakdale Alcoholism Unit (7 cases served from 7/76 to 7/77), seems to be underutilized. The documentation of underutiliza- tion comes mainly from providers of services who have informed us of specific instances where juveniles have been placed in jail for substance abuse problems. One-fifth of the popu- lation caseload of the probation officers is with juveniles who have charges involving drugs or alcohol (though this cannot be equated with addiction. 14. 3) There was concern expressed about the level of informa- tion regarding services as well as proper use of, or referral to, services such as counseling, birth control, venereal disease screening and its control. 4) Drug and alcohol education in the schools was of concern, but education about sex, legal rights, and family life were more often seen as in need of improvement. 5) Facilities for detaining juveniles who are inappropriate for the youth shelter are not satisfactory to most of those involved in using them. Iowa City has only a short- term holding facility, the County Jail, which is in poor condition. Its atmosphere is felt to be inappropriate for juveniles and therefore the Linn County Detention Center is used. The Detention Center is outside Iowa City but does provide an appropriate setting for juveniles. From July, 1976 to June, 1977, 12 Johnson County residents were assigned to the Linn County facility. The average stay for residents is four days, but Johnson County resi- dents have a little longer stay due to geographic loca- tion and the court schedule. Juvenile Probation is reluc- tant to send Johnson County clients requiring short term stays to Linn County because of the distance involved. The Linn County facility is open to Johnson County on a space available basis only. At.times Johnson County youth have been turned away because of this. To date, the placement of Johnson County residents has not posed a problem except for the distance involved. However, a need for a more appropriate alternative to the jail exists for those youths who have been turned away from the Linn County Detention Center. 6) The level of knowledge about juvenile affairs is affected by the procedures and processes for obtaining court appointed attorneys. The Bar Association submits the names of all Johnson County attorneys to the Court. Those attorneys who have heavy caseloads may strike their name from the list. This creates a tendency toward the list being comprised of new, inexperienced attorneys. 0 0 17. 7) There was some dissatisfaction expressed about the length of time between a juvenile being picked up and resolution of the charge, although this dissatisfaction was far from universal. One agency expressed concern about the need for crisis intervention with the family when the offense is committed. 8) One of the major concerns expressed by virtually all sources of information was the need for better communication and coordination between services. There may be a need to set some community standards for kinds of information shared between agencies that conform with the laws of confidentiality. 9) A.need for a greater variety of alternative supervised rec- reation opportunities for the marginal youth population was expressed. The Recreation Center Staff stated that these youth participate in behavior (e.g., smoking, swearing) which causes problems for other youth. It was felt by the Recreation Center staff that these marginal youth derive little benefit from the regular Recreation Center's programming. Group activities under leadership of accepted adults was seen as one way to handle this. The marginal youth population, such as pre -delinquent experiencing crisis and other maturation difficulties; need special recreational opportunities such as a place to dance and/or "hang out", would help. The Coralville Reservoir is also a problem area during the summer although young'adults as well as juveniles are involved. Additional patrolling of the area was suggested. 0 r7 18. 10) In the area of education, lack of sufficient vocational training opportunities and a lack of variety in vocational 11) 12) training courses offered were the main concerns. A need for more jobs for youth whose parents' income is just above the special job program (i.e., Summer CETA and Mayor's Youth Employment) eligibility guidelines and for youth too young (under 16 years of age) to obtain normal jobs was cited. In the area of work "training and job -seeking skills" was the greatest concern. Fifty-seven percent of agency per sonnel marked it in need of improvement. It was noted unsatisfactory by 21 percent. One-half of the agency respondents said that jobs available were either in need of improvement or were unsatisfactory, although 36 per- cent thought this area was satisfactory. "Career plann- ing help" and "help in locating jobs" received similar mixed responses from agency personnel. Very few school personnel considered any of these work areas unsatis- factory, but about 40 percent considered all these facets in need of improvement. Concern was also expressed for teenagers who may be exploited in job situations because of the vast supply of teens wanting jobs: Employers may not feel obligated to give breaks and lunch hours or set regular work schedules, and may feel free to withhold wages in cases of suspected theft. Many teenagers contact • • 19. the public library for advice on their legal rights in such circumstances. Jobs were mentioned in the response to the question about the greatest unmet needs by more respondents than anything else. One person described the need as "appropriate, gainful and sincere employment." Mayor's Youth and CETA were praised for their effective- ness but a need was seen for more "regular" jobs and jobs for those not eligible for special programs. 13) The questions on Youth Support Services about the family area as a support system indicated discontent by both agency and school personnel with the way families and youth interact. Following are the percent of school and agency personnel who found family support systems either in need of improvement or unsatisfactory: Areas in Need of Improvement or Unsatisfactory Amount of time parents devote to children Parents'.interest in childrens' activities Parents' understanding of childrens' .,.problems Parental discipline of children in helpful ways Availability of family counseling Programs to help parent/child understanding School Agency Personnel Personnel 75.5% 55.0% 67.5% 62.5% 55:0% 52.5% 77% 69% 77% 71% 50% 64% When agency personnel listed the greatest unmet needs, none mentioned any program for parents or families, although one police officer said "better parents" was the greatest unmet need. These responses could be a way of expressing frustration, blaming factors outside of agency or school control. .... ...... ... . LU. JOHNSONOUNTY JUVENILE PROBATION *ICE ANNUAL REPORT FOR 1976 Total Complaints Received During 1976------------------------------------------793 1975 Complaints Carried Over to 1976 ------------------------------------------ 38 1976 Complaints Pending 12/31/76 -------------------------------------=-------- 27 Total Complaints Handled During 1976 ------------------------------------------804 SOURCES OF 1976 DELINQUENT COMPLAINTS SOURCES OF 1976 CINA COMPLAINTS Boys Filed Girls Filed Total Without Without Boys Girls Acted Grand Action Action Handled Handled Upon Total Iowa City Police Department 39 12 156 50 206 257. Johnson County Sheriff's Office 31 20 99 31 130 181 Coralville Police Department 18 2 31 5 36 56 Iowa Highway.Patrol 6 0 14 8 22 28 University of Iowa Security 8 2 28 2 30 40 Other Courts 0 0 17 4 21 21 Department of Social Services 0 0 0 0 0 0 Schools 0 0 3 0 3 3 Parents 0 0 0 ., 0 0 0 Other 46 2 7 6 13 61 Totals 148 38 355 106 461 647 - SOURCES OF 1976 CINA COMPLAINTS Boys Filed Girls Filed Total Without Without Boys Girls Acted Grand Action* Action * Handled Handled Upon Total Iowa City Police Department 3 5 7 11 18 26 Johnson County Sheriff's Office 3 4 4 6 10 17 Coralviile Police Department 0 1 2 4 6 7 Iowa Highway Patrol 0 0 6 3 9 9 University of Iowa Security 0 0 5 1 6 6 Other Courts 1 0 3 3 6 7 Department of Social Services 0 0 35 22 • 57 57 Schools 1 6 4 5 9 16 Parents 0 0 0 2 2 2' Other 0 7 1 2 3 10 Totals 8 23 67 59 126 157 *Filed Without Action - this category covers reports from police or magistrate's court that had been taken care of by an officer or trate (e.g., possession of beer, a fine for some misdemeanor). magis- Cases handled - this category ranges from intake interview to court tion to commitment to a state institution. CARE PENDING DISPOSITION No Detention Juvenile Section of Jail Detention Center Emergency Shelter Foster Home Mental Health Institute State Juvenile Home Boys Training School Group Home Hospital Totals PREVIOUS REFERRALS Delinquent Delinquent CINA CINA 1976 Annual Report Girls Boys Girls Page 2 105 45 36 RACE 0 3 3 5 Delinquent Delinquent CINA CINA 0 Boys Girls �2Ys Girls White 346 102 64 56 Black 6 3 1 1 Indian 3 0 1 0 Other 0 1 1 2 Total 355 106 67 59 CARE PENDING DISPOSITION No Detention Juvenile Section of Jail Detention Center Emergency Shelter Foster Home Mental Health Institute State Juvenile Home Boys Training School Group Home Hospital Totals PREVIOUS REFERRALS Delinquent Delinquent CINA CINA Boys Girls Boys Girls 322 105 45 36 17 0 3 3 5 0 0 3 0 1 8 13 0 0 8 4 4 0 0 0 1 0 0 0 2 0 0 0 2 0 1 0 2 0 2 0� 4 Previous Contacts 17 5 1 355 10f 67 59 rc61101F1 568 11 4 4 587 TOTALS 508 23 8 22 12 4 2 3 4 587 Delinquent Delinquent CINA CINA Boys Girls Boys Girls TOTALS Multiple Referrals During 1976 107 10 8 3 128 No Previous Contact 203 80 54 50 387 1 Previous Contact 36 12 6 6 60 2 Previous Contacts 37 5 1 2 .45 3 Previous Contacts 27 1 4 1 33 4 Previous Contacts 17 5 1 0 23 5 or More Previous Contacts 35 3 1 0 39 Totals 355 106 67 59 587 • • 22. 1976 Annual Report Page 3 JUDICIAL DISPOSITIONS NON JUDICIAL DISPOSITIONS Delinquent Delinquent CINA CINA Total Total Boys Girls Boys Girls Delinquent CINA Dismissed 29 12 4 Dismissed, Not Proved 2 1 5 3 3 8 Warned 2 0 2 0 2 2 Probation Supervision 58 8 0 1 66 •1 Referred to Another Agency 8 •0 0 1 8 1 Runaways Returned to Parents 0 0 0 0 0 0 Held Open 8 1 0 0 9 0 Committed to Boys Training School 1 0 0 0 School 4 0 1 0 4 1 Committed to State Juvenile Home 0 0 0 0 Home ' 0 0 0 0 0 0 Transfer Custody to County Department of Social Services 0 0 0 0 0 Department of Social Services 2 0 10 7 2 17 Transfer to Adult Court 31 7 0 0 38 0 Other 3 0 2 1 3 3 Totals 118 17 20 13 135 33 NON JUDICIAL DISPOSITIONS Delinquent Delinquent CIiJA CINA Tdta1 Total Boys Girls Boys Girls Delinquent CINA Dismissed 29 12 4 7 ti 41 '11 Warned 119 60 3 2 179 5 Probation Supervision 22 4 1 2 26 3 Referred to'Another Agency 49 12 25 18 61 43 Runaways Returned to Parents 0 0 14 17 0 31 Held Open 16 1 0 0 17 0 Committed to Boys Training School 1 0 0 0 1 0 Committed to State Juvenile Home 0 0 0 0 0 0 Transfer Custody to County Department of Social Services 0 0 0 0 0 0 Transfer to Adult Court 0 0 0 0 0 0 Other 1 0 0 0 1 0 Totals 237 89 47 46 326 93 y1p 0 0 23. 1976 Annual Report Page 4 DECENNIAL REPORT: 1966 - 1976 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976** Delinquent Boys *106 285 443 361 435 390 386 449 502 350 355 Delinquent Girls 76 103 95 87 121 130 176 137 116 106 CINA Boys *28 41 II 12 27 16 19 18 33 25 67 CINA Girls 42 30 18 33 12 25 19 33 29 59 TOTAL *134 444 587 486 582 539 560 662 705 520 587 * Estimated or unavailable ** Change in definition of CINA cases CU. ru. fu fu D ru� I tu w u zr Ij u o w it tL f:.Uj c w X —j Z -w w P4 91, U) P. 7 co % I • CL lv- CU. ru. fu fu D ru� I tu w u zr Ij u o w it tL f:.Uj c w X —j Z -w w P4 91, U) P. 7 co • CL CU. ru. fu fu D ru� I tu zr CL lv- UJI w !g: 0. 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O'-1 E d V) H O�r. 0 II d P 04 O d d 0 d by U� P, 'I to a N l\ Cv tw d t` L1 U > .0 (n •d d l N 41 H N k H r l tD •H 0 N •H d H H •H 0 0) i � i H d r 41 •H •d 0 ,1'• bo d i .k O> Cn O M 1 41 490 F 0 3 1D F >. d H 10'-1 1D 1D F o o H N >, d C k H ml d d da E N O C H 44 x d > k H 4) d 4L d d C1 0 P.k OH -H • to CL C7 U n 'cf H - ctl C r H k H U O 0 vLW0 (n a H C d O d V o u O 6 U N O d •H N 3u 4J > .o 44 H H q aa ) a) �°� • Cl cn Cl. >4 •H 32. • APPENDIX III • DESCRIPTION OF LEVELS OF CARE AVAILABLE FOR JUVENILES The decision of what level of placement is most appropriate for a youth in the juvenile justice system is complex, involved, and somewhat subjective. The true picture of the process cannot be given in the following description; therefore, what follows is a general overview. As was mentioned previously, the "least coercive" level of care is the approach taken in Johnson County. However, this does not mean that a juvenile who enters the system for the first time will be placed in his own home. For instance, he/she may need to be temporarily placed in an alternative living situation rather than,his/her own home (e.g., foster care or emergency shelter). After a petition is filed in Juvenile Court, a study(s) or a social history and plan is done by the agency(s)'primarily involved with:the child. This study(s) is submitted to the Juvenile Court approxi - "mately 30 days after the petition is filed. At the end of this 30 day interim, the child's social, emotional, family and community life has been studied in depth. After assessing these aspects, recommendations are usually made to the Court as to the appropriate level of care for the child. The Juvenile Court judge reads the study(s), listens to the testimony from various agencies or people involved with the case reviews, and then makes the decision as to what level of care the child needs. The following are descriptions of alternative care programs - for youth from the UwASIS II Manual and supplemental narrative in regard to general characteristics of juveniles in each level of care.is added: 1) Family Foster Care: "Family Foster Care is a program designed to provide a substitute family life experience in an agency- 33. supervised home to children who need care for temporary or extended period during which the normal family environ- ment is either nonexistent or greatly hampered because of some social, emotional, or physical reason." This level of care is usually most effective with children from ages 0-12 years of age. After the age of 12, children do not adapt as well to family foster homes, at least initially, because their behavior patterns have solidified more than those of younger children. Adolescents who have reached the point where they are in need of an alternative living situation many times exhibit disruptive behavior that cannot be dealt with in the foster family home setting. 2) Group Home -Children: "Group Home -Children is a program de- signed to provide a comprehensive treatment -oriented living experience in an agency -owned or operated facility for children, who for some reason, are unable to adjust to their own foster homes and who are not suited for placement in an institutional setting. The program is geared to specific needs of the child into his or her eventual return to his or her own home and community as soon as his or her personal and social adjustment and development permits." Youth who are normally placed in group homes are having problems in their family setting, school setting (such as attendance, behavior, or failing), and the community. Although they are not model ,American children, they seem to possess a willingness to work on their weaknesses such as the following: compulsive behavior such as truancy; running away from their living situation; staying out late at night and in general, not following home rules; substance abuse; entering into family conflicts without some forethought; and being responsible. Johnson County has three group homes for children: Lutheran Social Services, Coffelt Group Home for Boys; and Youth Homes, Inc., which has both a Boys' and Girls' Group Home. Lutheran Social Services' Group Home is a less structured 34. setting than either of the Youth Homes, Inc. group homes. Lutheran Social Services is also available to out -of -county residents. The Youth Homes, Inc. group homes are more structured (such as stricter hours) and the residents from Johnson County are given priority. 3) Emergency Shelter Care -Children: "Emergency Shelter Care - Children is designed to provide temporary care and protec- tion in foster families, subsidized group homes, or group care facilities, until a satisfactory plan can be made,for children whose parents are unable to care for them and must be removed from their homes because of some emergency or crisis in the family, including neglect." In Johnson County there are foster homes that can be utilized in. crisis situations (mainly neglect and abuse). These foster homes are primarily available for children 0-12 years of age. These foster homes are not necessarily labelled emergency foster homes, but, upon request normally take children in crisis situations. There is also the Youth Emergency.Bhelter Care program for youth 12-17 years of age who are in a crisis situation (such as abuse,, neglect, delinquent, family conflict, ;runaways). The program provides counseling, housing and coordinated casework. Both Emergency Shelter Care and Foster Care theoretically provide or are geared toward temporary settings to allow an in-depth study of the circumstances of the youth so that the most appropriate intervention can be determined. There have been efforts made recently in the United States to maintain the child in the same foster care family utilized for emergency cases until the child can return home or needs a higher level of care. This is particularly true of children aged 0-12 years who would benefit from remaining where he/she has begun to adapt to that new family setting. To move a child from an • 35. emergency foster home setting to a "permanent foster home setting" or a long-term foster home setting adds another trauma in the child's already disrupted life. 4) Institutional Care -Children: "Institutional Care -Children is a program designed to provide substitute care in an institutional setting to those whom, for whatever reason, other living arrangements are not suitable. The program provides care and treatment to children who have behavior problems and/or who have parents unable to care for them adequately, and who require separation from their homes in a group living experience. The program is geared to the needs of individuals who are either not suited to a ,foster home or group home placement or for whom, for what- ever reason, no other substitute living arrangements are possible." The institutional or residential settings are more structured than group homes in that they are more restic- tive in allowing the residents to go "off grounds" into the community; they structure the daily lives much more than group or foster homes (such as structuring the attendance of school, requiring vocational training if not attending school, or requiring the residents to be involved in the group mileu the facility provides). This is particularly true of residents who have not been in the residential setting for a very long period of time. Youth who are placed in these settings have either severe physical, emotional, psychological problems, or a combination of these problems that cannot be resolved in less structured settings or settings which do not have the highly trained professionals that the residential settings have (such as access to psychiatrists, psychologists, and MSW's who are more readily available to the residents of these institutions or residential settings). Within the realm of residential care facilities are differing degrees of program approaches, structured living arrangements, and the kind of youth the facility will take. These differences • • 36. range from residential settings such as those in Hillcrest Services provided in Dubuque which do not allow for much deviance from their expected norms (or they are not accepted or they are expelled); to more tolerable, but still highly structured settings such as the Quad Cities Children's Center in Davenport, and New Dimensions in Cedar Rapids; and finally to settings which have the most incorrigible, hard-core delinquents in the state --such as Mitchelville and Eldora (these settings are the "most restrictive" due to the nature of their residents). To be placed in Eldora (boys) or Mitchelville (girls), you have to be adjudicated by the court as delinquent or be temporarily placed at these insti- tutions for an evaluation to see if the boy or girl is appro= priate for that level of care. Another distinguishing characteristic of residential settings is their acceptance of certain youth with differing levels of severity of emotional, physical, and psychological problems. As an example, Orchard Place in Des Moines has been known to take the more severe emotionally disturbed children that other residential settings felt were inappro- priate for their facility and their capacity to deal with their problems. . • 37. APPENDIX IV PROCESS BY I5HICH JUVENILES PASS THROUGli THE JUVENILE JUSTICE SYSTEM COMPLAINTS BY SCHOOLS, PARENTS, CITIZENS, OR OTHERS POLICE OR j SHERIFF WARNING PROBATION OFFICE COUNTY ATTORNEY DIS'KISSAL JUVENILE COURT ADJUDICATION I DISPOSITION I PLACITOUT-OF-liCMEDIS MENT STATE ATE TEAM I I COUNSEL NG I I INSTITUTION JOINT TREATDTENT, USING ANY COMBINATION OF ABOVE HUMAN SERVICES STUDY ADULT CORRECTIONS PROFILE October 7, 1977 Justice Sub -committee Members: Rex Honey - Chairman Doris Bridgeman Mary Boland Mardi Cooper Roger Darnell Carol Spaziani Staff: Connie Echternach Mary McCue Naomi Miller Johnson County Regional Planning Commission 22h South Dubuque Street Iowa City, Iowa TABLE OF CONTENTS Adult Corrections GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . 1 Service elements . . . . . . . . . . . . . . . . . . . . 1 PROBLEM DESCRIPTION. ... ,.... 1 SERVICE POPULATION . . . . . . . . . . . . . . . . . . . . 3 Johnson County Jail. . . . . . . . . . . . . 3 Sixth Judicial District Department of Correctional Services. 4 Bureau of Community Correctional Services. . . . . . . . 4 Project HOPE . . . . . . . . . . . . . . . . . . . . . 5 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . 6 Pre -Trial Release. . . . . . . . . . . . 6 Department of Correctional Services. . . . . . . . . . 6 Probation. 7 Department of Correctional Services. . . . . . . . . . 7 Parole . . . . . . . . 8 -Bureau. of Community Correctional Services. . . . . . . 9 Transitional Care of Ex -Offenders. . . . . . . . . . . . 9 Project HOPE . . . . . . . . . . . . . . . . . . . 10 Detention. . . . . . . . . . . . . . . . . . 11 Johnson County Jail . . . . . . . . . . . . . . . . . . 11 UNMET NEEDS . . . . . . . . . . . . . . . . . . . . . . . . 13 Housing . . . . . . . . . . . . . . . . . . . . 13 -Jobs . . . . . . . . . . . . . . 14 .Substance abuse -related problems 16 Johnson County Jail Facility . . . . . . . . . . . . 16 Other Needs . . . . . . . . . . . . . . . . . . . . . . . 17 APPENDIX Agencies - Adult Corrections 18 0 0 0 ADULT CORRECTIONS GOAL The goal of this service area is the promotion and preserva- tion of conditions that enable individuals to live in an environment where they feel safe and are protected from anti -social or ciiminal elements and where they can expect to receive legal justice and equal protection of the law and to resolve disputes:without recourse to force. SERVICE. AREA DESCRIPTION Adult corrections is designed to protect society and to treat and rehabilitate or contain violators and alleged law violators so that they are reasonably prepared for return at the end of a spec- ified period of restriction to their normal free status in the community Adult corrections- consists of three areas: 1) detention of law violators and alleged law violators, 2) pre-trial interven- tion, and 3) treatment designed to rehabilitate law -violators and to reintegrate them into society after conviction and/or detention. Service Elements: Pre-trial Release, Probation, Parole, Transitional Care of Ex -offenders PROBLEM DESCRIPTION Community-based corrections is being looked to as an alterna- tive to failing correctional institutions throughout the country, as well as in Iowa. Recidivism* rates are alarming and prisons have developed the reputation of ensuring that inmates become hardened criminals rather than rehabilitated citizens. "Overloaded, anti - *Recidivism refers to those individuals released from institutions who commit additional crimes. 2. quated, underfunded correctional institutions have created problems of near desperation for the administration and personnel who run them. The degree of this desperation has been intensified by the recent wave of disturbances and inmate rebellions across the coun- try."' "...The conditions within many prisons achieve nothing but an increase in recidivism. Eighty percent of all felonies are com- mitted by repeaters. These conditions may result also in the loss of self-respect and human dignity and lead to increased sophistication in criminal behavior through contact with hardened criminals. ,2 Not only are correctional facilities failing to rehabilitate, but it is projected that few individuals require the high security which prisons provide. "Experts agree that only 20 to 30 percent of. present inmates represent a danger to society and must be securely confined.113 Holding offenders in prison is expensive in terms of both direct and indirect costs to society. "The cost of keeping an adult offender in a state institution is about six times as great as that to keep him under parole supervision, and fourteen times as great as that required to supervise him on probation:a It was also estimated that, based on 1972 per capita costs, <"i.t takes -$11,000 per year to keep a married man in prison. This figure includes the inmate's loss of earnings, the cost to taxpayers if his family has to go on relief, and the loss of taxes he would pay.115 os commerce, 2Ibid, p. 5 3Ibid, p. 7 4Ibid, p. 8 5Ibid, p. 8 tizen Power 972, p. 2. tions. U. S. Chamber 3. The provision of services necessary to encourage resumption of normal life activities cannot be achieved by isolated and puni- tive facilities. Job -development and location are considered key to success in rehabilitation both by professionals working in the corrections field and by offenders themselves. "When ex -offenders are placed in appropriate jobs, their rate of recidivism is two to three times less than that of ex -offenders who do not receive job assistance."6 Two additional factors which increase the likelihood than an individual will not return to prison are placement in a higher -paying job and his/her ability to keep a job for more than six months. Probation and parole services are used as alternatives to confinement. Their aim is to assist the offender in rehabilitation while not removing him/her from the community. While two-thirds of all offenders are under one of these two programs, budgets for pro- bation and parole are often inadequate to effectively provide the necessary supervision and assistance toward reintegration into society. SERVICE POPULATION Both the service population and potential service population are contained in the information furnished by the agencies providing community-based correctional services. The Johnson County Jail has provided data spanning the 12 years from 1964 to 1976 on the numbers of individuals held in the jail: 6Ibid, p. 13 • 4. 1964 1966 1968 1970 1972 1974 1976 Adult'%les 190 249 393 382 489 540 731 Adult Females 10 15 42 26 44 25 51 Juvenile Males 16 23 55 88 93 95 57 Juvenile Females 2 7 17 23 29 30 12 TOTAL 218 294 507 519 655 690 851 Although the numbers continue to increase each year, no explanation was given for the large increase (22.6%) between 1974 and 1976. No data on age, income levels, or place of residence are available. The Sixth Judicial District Department of Correctional Services (Pre -trail Release and Probation Services) served 200 clients in fiscal 1977 (July 1, 1976 to June 30, 1977). The client population had the following characteristics: AGE SEX RACE 13-18 1% Male 95% White 90% 19-24 65% Female 5% Non-white 10% 25-35 30% 36-59 4% INCOME RESIDENCE Below $5,000 25% Iowa City 64% $5,000-$9,999 50% Coralville 16% $10,000-$24,999 25% Small Cities in Johnson County 15% Rural Johnson County 5% The Bureau of Community Correctional Services (Parole) esti mated that their 35 clients in fiscal 1977 (July 1, 1976 to June 30, 1977) had the following characteristics: 60 $ over 18 The agencies reported that the vast majority of their clients fell between the ages of 19 and 35, were male, lived in Iowa City and had incomes between $5,000 and $10,000. About 758 of the clients served in fiscal 1977 were carried over from the previous year. Project HOPE, a halfway house for ex -offenders, also furnished client information. Because of the nature of the service provided by this agency, their clients are most likely included in the counts provided by the agencies previously mentioned. Approizimately 70 clients were served by Project HOPE in fiscal 1976 through the residential:(60 clients) and job placement (10 cli- ents) programs. It was estimated that they have the following char- acteristics: 60 & over 28 INCOME Below $5,000 $5,000-$9,999 $10,000-$25,000 Residents SEX of half -way house only 208 758 Male 738 58 Female 278 All clients were residents of Iowa City. Project HOPE statistics are similar to those provided by the other correctional agencies. • • 5. AGE INCOME` RESIDENCE 19-35 848 Below $5,000 158 Iowa City 908 36759 158 $5,000-$9,999 858 Coralville 108 60 $ over 18 The agencies reported that the vast majority of their clients fell between the ages of 19 and 35, were male, lived in Iowa City and had incomes between $5,000 and $10,000. About 758 of the clients served in fiscal 1977 were carried over from the previous year. Project HOPE, a halfway house for ex -offenders, also furnished client information. Because of the nature of the service provided by this agency, their clients are most likely included in the counts provided by the agencies previously mentioned. Approizimately 70 clients were served by Project HOPE in fiscal 1976 through the residential:(60 clients) and job placement (10 cli- ents) programs. It was estimated that they have the following char- acteristics: 60 & over 28 INCOME Below $5,000 $5,000-$9,999 $10,000-$25,000 Residents SEX of half -way house only 208 758 Male 738 58 Female 278 All clients were residents of Iowa City. Project HOPE statistics are similar to those provided by the other correctional agencies. 0 0 6. SERVICES PROVIDED Correctional services provided locally are pretrial release, probation, parole and transitional care of ex -offenders. Pre=trial Release is a program designed to provide a speedy rehabilitation response for offenders as soon as possible after their arrest but before trial, conviction and sentencing. Offenders are placed into a program which provides supervision, counseling, training and employment assistance. The Department of Correctional Services serves the counties of the Sixth Judicial District. The program is administered through a board of directors composed of members of the, County Boards of Supervisors in the Sixth Judicial District. Funding for the pro- grams comes through a grant from the pre -institutional arm of the Department of Social Services. A point system, -.based on indicators of stability and likeli- hood of appearance for trial, is used to determine whether pre-trial release will be granted. - The point requirements are as follows: 1 to 2 pts. No release on own -recognizance. 2 to 5 pts. Release under supervision of the Department of Correctional Services. 5 to 13 pts., Release on own recognizance. The points are assigned on the following bases: RESIDENCE 3 - Present residence one year or more 2 - Present residence 6 months, or present and prior 1 year. 1 - Present residence 4 months, or present and prior 6 months. Add l - For Johnson County resident for 10 years or more. 9 • • 7. FAMII'LY TIES 3 - Lives with spouse*and had contact** with other family members 2 - Lives with spouse or parents 1 - Lives with family person whom he gives as reference *Spouse (If common-law, must have been living together for two years to qualify as "spouse"). **Contact (must see the person at least once a week). EMPLOYMENT 4* - Present job one year or more 3* - Present job four months, or present and prior 6 months 2* - Present job one month 1* - Current job or unemployed 3 months or less with 9 months or more on prior job or receiving unemployment compensation or welfare or supported by family (full-time housewife considered employed) *Deduct one point from first three categories if job is not steady, or if not salari'efl, 'if defendant has no.investment in it. CRIMINAL RECORD 2 - No convictions 1 - No conviction within the past year 0 - No felony convictions, or misdemeanor conviction(s) within the past year. -1 - Two or more felony, convictions. Probation is defined as a program designed to treat and rehabilitate law violators so that they are reasonably prepared for return, at the end of a specified period of restriction, to their normal free status in the community. The Sixth Judicial District Department of Correctional Services also administers the probation program. It is aimed at rehabilitation of selected offenders and involves conditional suspension of sentence, pro- vision of supervision and treatment in the community, and the abandonment of punitive action if the conditions (primarily good behavior) are complied with. A probation officer is legally charged with.administering the controlled status and specific or general 0 8. conditions of probation concerning his client's mobility, employ- ment, social relationships, and the like. The objective is to effect the restoration of the offender to normal community living so that controls may no longer be necessary. In addition, probation sustains the offender's ability to continue working and to protect his family's welfare, while avoiding the stigma and possible damaging effects or imprisonment. The Sixth Judicial District Department of Correctional Ser- vices conducts a pre -sentence investigation. Recommendations based upon the information brought forth are given to the court. The ac- tive case load is about 35 clients per month. Referrals are made to Reality X, Oakdale Detoxification Unit, Psychiatric Hospital, Mount Pleasant, and Voss Recovery House for supportive services. A pro- gram for specialized services in job -development and alcoholism - counseling funded by Johnson County has recently been added. The courts, County Attorney, and defense attorneys influence the nature - of the service provided by the Department. The Department has joint meetings regarding overall treatment with Voss House weekly, Psychia- tric Hospital monthly, and Oakdale Alcoholism Center bi-monthly. The budget for fiscal 1977 was $950,000, provided by state and federal funds. The program will be totally state -funded in fiscal 1978. Parole is a program designed to provide for conditional release of a selected convicted person before completion of the term of im- prisonment to which he/she has been sentenced. The parolee, though released from detention, continues to remain in legal custody of the state or its agent and may be reincarcerated in the event of legal 0 • • 9. misbehavior. Parole is a measure designed to facilitate the transition of the offender from controlled institutional living to the freedom of community living. Parole refers to treatment after release from a penal institution whereas probation is used in lieu of confinement. The Bureau of Community Correctional Services, the institu- tional arm of the Department of Social Services, administers parole services. Funding for parole comes entirely through this source. Clients are referred to the program from the Iowa State Penitentiary, the Men's Reformatory, the Women's Reformatory, and by out-of-state transfers to Iowa. Clients of the parole office are referred to Job Service of Iowa, Psychiatric Hospital, and the Community Mental Health Center for counseling, MECCA for alcoholism counseling, the Johnson County Department of Social Services for financial assistance including ADC, and the Oakdale Hospital Detoxification Unit. The Department of Social Services and Bureau of Community Corrections influence the nature, of the services delivered. Transitional Care of Ex -offenders is a program designed to provide small, homelike residential facilities located in the commu- nity for ex -offenders who have come out of institutions and need a a gradual readjustment to community life. The program offers super- vised living and counseling. Community resources for education, training, jobs and recreation are used to facilitate the ex -offender's transition to a normal existence. , . r 0 10. Project HOPE, in addition to providing a structured living environment for ex -offenders, provides counseling and assistance in procuring and maintaining employment. The program is aimed at helping the ex -offender to become a self-supporting individual who accepts responsibility for his/her own actions. Assistance in ob- taining jobs is given to non-resident ex -offenders as well. A total of 58 job placements (including 10 for non-residents) were made in the 9� months betweeen July 16, 1976 and April 29, 1977. Project HOPE has until recently operated two halfway houses in Iowa City for ex -offenders, one for males and one for females. At present, however, due to policy changes made by the Department of Social Services, only one co-ed facility is in operation. The half- way house provides housing for individuals on work release or parole. Services to individuals on pre-trial release or probation is being phased out. The co-ed facility will house a maximum of twelve individuals and: will serve more women than men since this is the only facility which'accepts women, whereas there are several other options for males. Funding for the project is currently provided through the post -correctional institution arm of the Department of Social Services. Referrals to Project HOPE are made by probation, parole and pre-trial counselors, prison work release programs, attorneys, Reality X, MECCA, Vocational Rehabilitation, and Psychiatric Hos- pital. Due to funding limitations, only individuals returning from correctional facilities may be housed by Project HOPE. Clients must wait 2 to 4 weeks to become ares - ident of Iowa City before receivin-2- ..._. service. The average number of clients on the waiting list is 6 men 11. and 3 women. The Iowa Cringe Commission and the Department of Social Services have influence over the nature of services provided. Project HOPE has a joint planning/advisory relationship with the Bureau of Adult Corrections. Project HOPE refers clients to CETA and Job Service of Iowa for em- ployment, Vocation Rehabilitation for education and job training, Psychiatric Hospital and the Community Mental Health Center for psy- chiatric care, MECCA for alcohol problems, and Reality X for drug problems. :- Detention of offenders is provided at the Johnson County Jail. The Jail is primarily a holding facility, with very short-term per- iods of detention. Examples of the nature of offense and duration of detention of those entering the Jail in June, 1977 are shown .-below. .Eighty-eight persons who entered the Jail had been given the following sentences: 2� months - falsifying bank checks " 1 year - larceny 3 days - criminal tresoass 17 days - OMVUI* (4th offense) 22 days - probation violation 5'days - receiving stolen propterty 21 days - receiving stolen propterty 2 days - driving under suspension 18 days - failure to appear in court 4.days - embezzlement 4 days - OMVUI Most arrests (40-50%) involve OMVUI. These offenders spend the night in jail and then are released on bail. They cannot be transferred to the Oakdale Detoxification Unit because they have committed an . indictable offense and must be held in a secure facility. Chronic >.. alcohol abusers are brought to Oakdale after repeated arrests if *OMVUI - Operating a Motor Vehicle While Under the Influence • • 12. they have committed no other indictable offense. Because the length of stay at the Jail is usually so short, it is hard to justify add- ing staff for specialized programming. At the present time individ- uals incarcerated in the Jail may see a clergyman or lawyer upon request, and recieve regular weekly reading, information service and writing workshops provided by the Iowa city Public Library, but do not have access to human service personnel, luch as social workers, through other community agencies. The budget for the 1976-77 fiscal year was $94,250. Funding 0 r 13. The staff of Heritage Agency advises the elderly of their legal rights and handles administrative (SSI, Social Security, food stamps, IPERS) appeals. For those cases which are fee - generating (e.g. wills, conservatorships, legal suits involv- ing claims for damages) the individual, if low-income, is re- ferred to Legal Aid or to an attorney who has agreed to work for a reduced fee. The program director has seen about eight Johnson County cases involving exploitation since October, 1976. These cases generally involved exploitation by families or nursing homes. A total of 475 Johnson County clients were served through the Legal Services for the Elderly program in 1976. Hawkeye Legal Aid Services provides legal counseling, advocacy and representation to low-income people through a staff attorney system. Approximately 5 percent of the John- son County, elderly population (about 25 individuals) was served during 1976. The Legal Aid Services can deal only with civil matters and cannot become involved in criminal ;',:, prosecution. PRO*IVE SERVICES TO THE ELD* 14. UNMET NEEDS Potential Service Population - In the 1977 Iowa City Citizen's _._--_Survey section on human services, the most clearly identified priority was increased attention to services for the elderly. Of the res- pondents, 41.7 percent saw the elderly as first in importance in planning for new or improved services in the community. Services to the elderly living alone was seen as "Definitely" needed by 34.3 per- cent of the respondents. It was ranked second in importance after information and referral. The next highest was Day Care for the Elderly where 29.9 percent said "Definitely and 39.8 percent said it was "Probably" needed. Examples were given by individuals working with the elderly of abuse,neglect and exploitation. Those examples centered around four main areas: families, medical professionals, nursing homes, and fraud or "bunco artists." Abuse, neglect and exploitation by families was one of the more common situations cited. An individual spoke of families who took over the elderly person's home or expected an elderly person to do chores in exchange for a domicile. Physical abuse or neglect were also mentioned. The Council on Aging stated that children "dump" weir^parents at the Close-Mansioa,_delegating responsibility for their care to the agency. SEATS personnel cited 4 or 5 cases of children placing their parents prematurely or unnecessarily in institutions. MECCA also found spouse abuse among elderly couples with a history of alcohol involvement. Abuse or neglect in the home cannot always be followed up. The family can refuse admittance to an investigation under these circumstances, unlike child abuse cases. Abused elderly know the possibility of retribution and will not disclose acts of neglect they suffer at the hands of their children. Medical Personnel may not be as sensitive and responsive to the special needs of the older person as is necessary. An example of this is in the medication given and in the instruction on how to take the medication. The Health Service Agency Plan reports that "drugs are given far too readily with inadequate consideration for the changing physiology • • 15. `--" "of -the aged." Individuals contacted as part of our study were concerned that proper and patient instruction be given on hc:: Lo take medication. Some elderly are afraid of taking an overdose and as a result do not take enough, while others overdose because they are confused about the proper amount or cannot remember if they have taken it already. The Health Services Agency Plan recom- mends that "careful periodic review of all drugs prescribed for each patient is critical. Patient awareness of common errors in self-medication must be heightened. It was also felt that impatience on the•part -of'medical petsonneI'and the long wait required prior to being seen by the physician, particularly at the University Hospital, may put the health of the elderly in jeopardy. Fraud - A police officer felt that the elderly were a prime target of crime in the community. Burglarly, mugging and fraud com- mitted against the elderly are serious problems. He stressed the need for preventive and crime awareness programs. Nursing Homes - A great deal of discussion centered around abuse and neglect of residents in nursing homes. Examples were given of slapping, forcing food too quickly for the patient to swallow, cold food being served and people being dropped into chairs. Placement -of the individual in the proper level of care was also of concern. Three separate mechanisms have been established to monitor the care of patients: the Care Review Team from the Department of Social Services, Dept. of Health Consultation and Licensing Division,. and the Care Review Committee at each facility. Violations may result in revocation of the license by the Health Dept. Few cases of abuse or neglect have been reported or verified, however. The elderly are, however, often too afraid of these "advo- cates" to report abuse or neglect. The relationship between the Care Review Team and nursing home staff is often reviewed as antag- onistic, thus cooperation may be less than ideal. In order to keep costs down - which administrators must do if they are to be able to afford accepting medicaid patients - staff may be poorly paid or understaffed 'and ill -trained in working with the elderly. • • 16. Legal Rights to Services - Several questions were also raised in regard to the legal rights of the elderly. They may not be aware of their rights in guardianships and conservatorships, or their options in nursing home placement. They may also be con- fused as to bureaucratic procedures associated with assistance programs resulting in benefits being terminated to their detriment. Elderly individuals often times have other difficulties in locat- ing and securing the services they need. Although two sources exist for legal assistance (Hawkeye Legal Aid and Heritage Agency on Aging Legal Assistance Programs) these were not felt to be adequate. Heri- tage cannot do extensive investigation nor can they handle a crimi- nal prosecution. The sub -committee felt that there was an absence of legal remedies for many of the abuse, neglect and exploitation problems of the elderly. Data Collection - In discussions with personnel of agencies serving the elderly, it was difficult to document cases of abuse, neglect and exploitation, partially because the victim is reluctant to disclose such instances. Yet there is general agreement that there is a serious problem in this area. More extensive data col- , lection is needed if specific problems are to be pinpointed, and action taken to alleviate them. 0 AGENCY J.C. Department of Social Services 0 0 17. SERVICES PROVIDED FINANCED BY SERVICE PLUS # OF CLIENTS DSS then Title XX Protective Services after 90 days Resolve abuse, neglect complaints. Clients: 28 this past year, 700 hours service. Homemaker Services 147 households 17.1% over 60. Iowa City, United 2,000 clients, all over Way, Heritage,Space 65. Outreach, advocacy from County with other agencies, Friendly Visiting ect. Chore services. Federal funding Outreach services Winterization (no ques- tionnaire returned) Federal, State Legal information and referral; legal services 475 clients, all elderly I & R Federal Should serve low-income elderly with legal services; 5% of 500 clients over 60 (25) County, State Outpatient and resi- dential services to alcoholics; about 30 clients over 60 or 10% of total number. AGENCY Mark IV E FINANCED BY United Way 18. SERVICE PLUS A OF CLIENTS Advocacy. Clients: about 14 over 60. Emergency services. Clients: about 14 over age of 60. Friendly visiting/ telephone reassurance (service information). About 60 clients. Informal counseling. 50% of 70 clients. (35) State *Receive complaints concerning nursing homes and report to No Funding the State Public Health Department. *Do yearly or bi-annual check-ups of all patient * These services per- formed by both the D.S. S., Care Review Team and the Care Re r, view Committee. State Department of State Licensure and inspection Health of facilities, investi- gation of complaints against care facilities. NOTE: Other groups serving elderly with support services may also play a part - see Family and Individual Services. 0 4 ILL_Qrw. HUMAN SERVICES STUDY COUNSELING PROFILE October 7, 1977 Mental Health/Chemi6al Dependency Sub -Committee Members: Verne Kelley - Chairman Gladys Benz Graham Dameron David Henson Paul Huston 3 41o56 • TABLE OF CONTENTS Counseling GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . 1 Service Elements . . . . . . . . . . . . . . . . . . . . 1 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . 3 Divorce rates. . . . . 4 Other problems affecting families and individuals. . . . 6 School surveys . . . . . . . . . . . . . . . . . . . . 6 Bar association survey . . . . . . . . . . . . . . . 7 POPULATION SERVED . . . . . . . . . . . . . . . . . . . . . 8 University Counseling Service . . . . . . . . . . . . . . 8 Lutheran Social Service. . . . . . . . . . . . . . . 9 Social workers in private practice . . . . . . . 9 Agencies who provide counseling as a major portion of their program . . . . . . . . . . . . . . . . . . 10 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . 19 Agencies or individuals with counseling as their primary purpose. . . . . . . . . . . . . . 19 University Counseling Service . . . . . . . . . . . . . 19 Lutheran Social Service. 20 Counselors in private practice . . . . . . . . . . 20 Agencies who provide counseling as a major component of their programs. . . . . . . . . . . . . 21 Department of Social Services . . . . . . . . . . . . . 21 Intensive in-home treatment . . . . . . . . . . . . . . 22 -. Foster home care . . . . . . . . . . . . . . 23 Group home care for children . . . . . . . . . . . . . 24 Transition to independent living . . . . . . . . 27 Informal "street counseling" to youth. . . . . , . . . 28 Crisis intervention services . . . . . . . . . . . . . 31 Support groups . . . . . . . . . . . . . . . . . . . . 36 Other counseling resources . . . . . . . . . . . . . . 38 MAJOR UNMET NEEDS/PROBLEMS IN THE SERVICE DELIVERY SYSTEM, 41 Inadequate cooperation and coordination among agencies . 41 Conciliation services. . . . . . . . . . . . . . 41 Shortage of personnel at some agencies . . . . . . 42 An increase in the number of single parents who are seeking assistance . . . 43 A need for more comparable and valid data collection among agencies43 Other problems cited by*agencies and individuals 43 9-23-77 COUNSELING PROFILE GOAL To reduce and/or alleviate the emotional problems and temporary stresses encountered by Johnson County families and individuals. SERVICE AREA DESCRIPTION Counseling (casework or casework counseling) is a program which uses the casework method (i.e., a professional relating to a client via an interview, talking, discussion and lending a sympathetic ear) to advise and enable families and individuals within a family unit or individuals not living as part of a family, to come to grips with and to resolve emotional problems or temporary stresses encountered by them. Under this program, a counselor helps his or her client with an experience or opportunity in which the client can express his/her - attitude and feelings about a problem of social functioning and can gain a new perspective through discussion of a possible means of handling it. Counseling may be on a one-to-one basis or group basis and may be conducted by volunteers under the supervision of professional staff. Service Elements: Service elements include counseling of some, or all of the following: children, families, out -of -wedlock pregnant girls, unwed parents and couples, adoptive parents, married couples, divorced indi- viduals, couples contemplating divorce, VD -prone youths and adults. It is recognized that most human services invariably include some "counseling". This must be distinguished from the above - defined counseling program where counseling is the major, not the sole, activity. s 2. Note 2: In this profile, a distinction between counseling services and mental health treatment services is made. Although the mental health treatment agencies (e.g., Mid -Eastern Mental Health Center, individual providers, Psychopathic Hospital, Research and Training Clinic, and others listed in the mental health profile) perform family and individual counseling or therapy. They do not consider it their primary focus, whereas the agencies included in this profile have as their main thrust, family and individual counseling. K • PROBLEM DESCRIPTION 0 3. Social functioning of individuals can be hampered by many prob- lems and stressful situations. Among these are marital conflicts, parent/child conflicts, difficulties with interpersonal relationships, career or occupational pressures, problems associated with aging or stress associated with societal conditions or personality. The Mental Health Center, which provides counseling as well as treatment of mental illness, recorded the problems with which clients need assistance. The Crisis Center, which provides over -the -phone or walk-in counseling of a different sort, also recorded their clients problems. Table 1 includes a partial listing of those problems. Table 1 Problem Mental Health Crisis Center Center Contacts Contacts Marital problems 211 160 Family relationships 151 387 Depression 68 372 Identity 66 Anxiety 44 ! Anti -social behavior 29 " Post-marital/Divorce 26 146 Peer relationships 15 School performance 12 160 Sexual 18 203 Physical functioning it Obsessions -Compulsions 7 Pre -marital 7 Mental retardation 2 Substance use or abuse 4 366 Suicidal 6 126 Interpersonal 597 Loneliness 449 Financial or employment 365 Pregxiancy or abo;tion 151 TOTAL 677 3,482 0 Clergymen in Johnson County were asked to indicate if they provide counseling to people, and if so, what kind. Seventeen of the twenty clergy responding to the survey indicated that they did provide counseling. Table 2 shows the type of counseling they are called upon to provide and the number of clergy providing such counseling. Ta1,iu 7 Type of Counseling Provided: Marriage 1s Depression 10 Career 8 Pre -Marital 7 Male -Female Relationships 6 Family/Parent - Child 6 Life Adjustment/Identity 6 Academic/Occupational Choice 6 Spiritual/Theological 4 Alcohol/Drugs 4 Problem Pregnancy 4 Transient 4 Health Crises/Death 3 Other types of counseling mentioned concern these areas: homosexuality, women, financial problems, and the occult. Divorce Rates 4. Johnson County, with a divorce rate of 5.2 per 1,000, was the fourth highest in the state of Iowa. Population was not the sole determinent of the divorce rate since Johnson County ranked seventh among the counties in population, and three of the counties with greater population ranked lower than Johnson County in divorce rates. The divorce rate for the state as a whole was 3.6, significantly lower than that of Johnson County. Flirty -one and six tenths percent of the Johnson County dissolutions in 1975 occurred in marriages of 0-4 years in duration. Sixty percent of the state dissolutions granted involved chil- dren under age 18. No comparable data is available for Johnson County divorces involving children. • • 5. The marriage rate for Johnson County (8.1/1,000) was slightly lower than the state average of 8.9. Chart H1 below shows that while the marriage rate for the State of Iowa has been declining in the 197O's, the dissolution (divorce) rates have been rapidly increasing. MARRIAGE AND DISSOLUTION RATES 1945 - 1975 Occurrence Rates Rate Per 1,000 Population CHART N1 *Vital Statistics for Iowa, 1975, p. 5. No comperable data is available for Johnson County. RATE 0 1J 1915 1950 1955 1960 1965 1970 197 1'EAA • 6. other Problems Affecting Families and Individuals School Surveys: School personnel in Johnson County were sur- veyed in May, 1977 to gain their opinions on problems facing youth and their families. Forty questionnaires were returned by school principals, vice -principals, counselors and nurses. The school personnel were asked if they are seeing a change in the incidence of certain problems facing children and their families. The question and responses are shown in Table 3. Table 3 Question: Are you seeing a change in the incidence of the following problems facing children and their families? Increase No Change Decrease No Response Problem N % A % N % k % Emotional Family Stability Identity ,Problem Pregnancy Drugs Alcohol Disruptive Behavior Delinquency Absence from School Drop -outs Suspected Child Abuse or Neglect 24 60.0 13.0 32.5 1 2.5 2 5.0 17 42.5 5.0 12.5 12 30.0 6 15.0 8 20.0 23.0 57.5 3 7.5 6 15.0 10 25.0 16.0 40.0 5 12.5 9 22.5 6 15.0 22.0 55.0 6 15.0 6 15.0 14 35.0 18.0 45.0 0 0 8 20.0 11 27.5 19.0 47.5 10 25.0 0 0 9 22.5 21.0 52.5 7 17.5 3 7.5 12 30.0 19.0 17.5 7 17.5 2 5.0 1 15.0 23.0 57.5 6 15.0 10 25.0 6 15.0 27.0 67.5 2 5.0 5 12.5 Many persons (42.5%) cited family stability problems as increasing. A small percentage (12.5%) of the respondents felt that there has been no change in family stability. An ambiguity in the data arises, for thirty percent indicated a decrease; the contradiction would be eliminated if it could be concluded that the respondents were indicating a decrease in 0 • 0 7. family stability rather than a decrease in family stability problems (the wording of the question is misleading). In support of this in- terpretation is the negative response of 50-60% of the respondents to the amount of family support of youth as seen in Table 4. School personnel were also given a list of support services and asked to rank each. Table 4 shows the responses for the family support services. Table 4 N=40 Support Families f Amount of Time Parents De- 1 vote to Their Children Supervision of Children 1 by Parents Parent Interest in Child rents Activities 1 Parent Understanding of Children's Problems 0 Parent Discipline of Child -0 ren in Helpful Ways Availability of Family 5 Counseling programs to Help Parent- 4 Child Understanding from Children are ProtectP Parent Abuse or Neglect by 2.5 0 0 12. 10. 7. Satis- Needs Unsatis- Don't V"nW 2 4 11 8 11 B 13 5. 22I 10 0. 21 27.5 22 20. 24 20 • 22 27.5 19 200 17 32.5 13 55.0 52.5 55.0 60.0 55.0 47.5 42.5 37.s 7 8 b 3 3 3 4 5 17.5 20.0 .0 7.5 7.5 7.5 10.( 12.`. .4 3 3 2 4 4 4 4 10.0 7.s 7.5 5.0 10.0 10.0 10 Al 10.( 10 3 3 3 3 .2 3 5 23.0 7.5 7.5 7.5 7.5 5.0 7.5 12.5 The school personnel expressed a concern for family support of youth. d' arental protection of children from abuse Except for the item regar ing p 42.5 or neglect, every item related to family life was overwhelmingly to 60%) marked, "needs improvement". Bar Association SurveL A human services questionnaire was mailed to all 110 Johnson County members of the American Bar Association. A total of 22 ques- tionnaires were returned. 0 �J I They were asked to rank a number of factors according to what they were seeing as contributing to family disruption. They were also asked to indicate any change in incidence noticed. When the responses of the attorneys were averaged, the following rankings were made: 1. Changing roles or life styles of marriage partners. 2. Money management and/or insufficient money. 3. Poor communication. 4. Sexual problems. 5. In-law difficulties. 6. Problems with children. Changing roles or life styles of marriage partners was seen to be increasing significantly by 10 of the 11 attorneys responding to that question. Money management and/or insufficient money was seen to be an increasing factor by four attorneys while five felt that this factor was remaining stable. Other problems cited were alcohol and physical abuse. POPULATION SERVED Agencies and Individual Practioners with Counseling as their Primary Purpose University Counseling Service provides academic, vocational, and personal development counseling to students and staff at the University of Iowa. Over 500 clients were served from June 1, 1976 thru May 31, 1977. During this time, 5,200 counseling hours were provided. Nearly all clients are between 19 and 24 years of age and reside in metropolitan Iowa City. • 9. About 90 percent are white. Women comprise about 60 percent of those counseled. Client characteristics (estimated percentages) are sum- marized below: AGE SEX RACE 19-24 years 90% Male 40% White 90% 25-35 years 10% Female 60% Non-white 10% RESIDENCE Metropolitan Iowa City 95% Small Towns/Johnson County 5% Lutheran Social Services provides casework counseling by pro- fessional social workers to families, individuals, and couples desiring such counseling. The total number of clients seen by Lutheran Social Services in the family counseling program in 1976 was 110; 80 new clients and 30 from the previous year. Client characteristics based on estimates are summarized below: AGE SEX RACE 0- 4 3% Male 30% White 95% 5-12 5% Female 70% Non-white 5% 13-18 15% 19-24 15% 25-35 40% 36-59 22% INCOME RESIDENCE $ 5,000 - 9,999 60% Iowa City 60% 10,000 - 24,999 35% Coralville 20% 25,000 and Over 5% Hills 1% Oxford 1% Solon 2% Riverside 2% North Liberty 2% Tiffin 2% Social Workers in Private Practice provide counseling in a pri- vate practice setting. Information on the number of people served by private practitioners is incomplete. Of•eight social workers responding to 0 0 10. a questionnaire during June of 1977, only two indicated that they are in private practice. One of the respondents indicated that less than 10 people per year are seen. The other did not indicate the number served. It can be assumed that a limited number of people in Johnson County are counseled by social workers in private practice. AGENCIES WHO PROVIDE COUNSELING AS A MAJOR PORTION OF THEIR PR—ORTRAM The Johnson County Department of Social Service provides counsel- ing as an integral part of its protective services for children which is designed to alleviate abuse or neglect of children. The Protective Services unit served 380 clients from July 1, 1976 to June 30, 1977. Twenty of these clients were carried over from the previous year. Clients were provided with 93,600 hours of casework counseling. Client charac- teristics are given below. All percentages are estimates. AGE 0-4 years - 30% 5-12 years - 30% 13-18years - 40% FAMILY INCOME Under $5,000 - 5% $5,000 $9,999 - 25% $10,000 $24,999- 60% $25,000 over - 10% SEX Male - 50% Female - 50% RACE White - 95% Nonwhite - 5% RESIDENCE Metro Iowa City - 80% Iowa City - 48% Coralville - 28% University Heights - 4% Other Areas/Johnson County- 20% Families, Inc. provides intensive in-home treatment to severely disfunctional families in a nine -county area. About 20 families (100 in- dividuals) from Johnson County were served from July 1, 1976 thru June 30, a 0 • 0 11. 1977. Approximately five of these families were carried over from the previous year. The majority (90%) of client families have incomes of under $10,000. Ninety-three percent of the Johnson County clients reside in metropolitan Iowa City. About 80 percent of clients are white. Males and females each comprise about half of the client population. Children. of all age groups are served. Data on Johnson County clients is shown below. Percentages are estimates. AGES (children only) SEX 0- 4 year - 33% Male - 50% 5-12 year - 33% Female - 50% 13-18 year - 34% FAMILY INCOME Under $5,000 - 60.1 $5,000 $9,999 - 30% $10,000 $24,999 - 8% $25,000 and over - 2% RACE White - 80% Non -White - 20.% RESIDENCE Iowa City - 80% Coralville - 10% University Heights - 3% Other Areas/Johnson County - 7% Johnson County Social Services and Lutheran Social Services both have programs which provide for foster home care to children whose family environment is not functioning to provide for a normal upbringing. Johnson County Social Services provided foster home care to a total of 118 children during the year beginning July 1, 1976 and ending June 30, 1977. Seventy-nine clients were carried over from the previous year. Data which was provided on client characteristics pertains only to 39 clients, which is the number of new clients served during fiscal 1977. Most of the clients served were under 12 years of age, the majority of these being less than 5 years old. The majority of new clients were male and white. Data on residence and family income is not kept data'•is shown on the following page. Available 0 • 12. AGE 0- 4 years - 49% 5-12 years - 31% 13-18 years - 20% SEX Male - 76% Female - 24% Lutheran Social Services has indicated two clients in the Foster Family Care program in its budget for 1978. Information on the number served dur- ing the past year and on client characteristics should be obtained soon. Youth Homes, Inc. and Lutheran Social Services offer group home care nrograms designed to provide a comnrehensive treatment -oriented living experience to children who cannot adjust in their own home or in a foster care setting. Youth Homes, Inc. has a boys' group home and a girls' group home. The boys' group home was opened on November 18, 1976 and served five Johnson County residents thru May 9, 1977. Clients must be under 18 years -of age. All clients have been white males.and residents of Iowa City. Estimates pf family incomes are as follows: FAMILY INCOME $5,000 - $9,999 - 60% $10,000 - $24,999 - 40% The girls' group home was opened on February 1, 1976 and served five girls from Johnson County and six from outside of the county thru December 31, 1976. Clients must be under 18 years of age. Most clients have been white. Of the Johnson County clients served, 71% were from Iowa City. Data on client characteristics is given below. RACE (all clients) White -91% Non -White - 9% INCOME (J.County Clients RESIDENCE (J. County only estimates) Clients only) $5,000 - $9,999 - 60% Iowa City - 710% $10,000 - $24,999 - 40% Oxford - 14.5% Solon - 14.5% E 13. Lutheran Social Service has a boys' group home, Coffelt Place. The 1978 budget includes group home care for six boys. Hillcrest Family Services and Iowa Childrens' and Family Services, although not located in Johnson County, provide group home care services which are available to Johnson County residents. No clients from Johnson county are presently being served by the two group homes which Iowa Chil- drens and Family Services runs. No data on clientele has been obtained from Hillcrest Family Services. Youth Homes, Inc. and Iowa Childrens' and Family Services provide programs for transition to independent living to adolesecents 17 to 18 years of age who have previously been in foster care or group home situations. Youth Homes, Inc. began its Transition to Independent living pro- gram on February 1, 1977 and served a total of four clients during the first four months. Two of the clients were Johnson County residents, one from Iowa City and one from Hills. One of the clients is female, the other male. Three of the total four clients have family incomes in the $5,000 to $9,999 bracket; the income of the other client's family was in the $10,000 to $24,999 bracket. Iowa Childrens' and Family Services, located in Des Moines, provided supervised independent living care to one Johnson County client who en- tered the program on January 20, 1977 from foster care. United Action for Youth provides informal "street" counseling to youth through its outreach program in an effort to meet their individual needs and to provide them with opportunities related to personal interests. r • 14 A total of 166 young people were served by the program from July 1,. thru December 31, 1976. Of these 117 were new clients and 49 were carried over from the previous year. Nearly all clients (900) were between the ages of 13 and 18. The majority (580) were male. Most of United Action for Youth's clients (850) reside in Iowa City and Coralville. Data on race and income of clients is not maintained. Other data is shown below. AGE 5-12 years - 70 13-18 years - 900 SEX Female - 420 Male - 580 RESIDENCE Iowa City -650 Coralville -200 University Hts. - 80 Hills - 20 Oxford - 20 Solon - l0 Lone Tree - 1% N..Liberty - 1% Crisis Counseling The Iowa City Crisis Center provides short-term crisis inter- vention services, community education, assistance to youth, and infor- mation and referral at no cost to clients. In 1976, 1,634 units of _service (one unit = one client contact) were provided by the crisis intervention program. The community edu- cation program served 650 clients in 1976. A total of 1,752 contacts for information and referral were made during the year. The Youth line, initiated on March 1, 1977, received 40 contacts during the first three months of operation. The following statistics on the population served by these programs in 1976 have been provided by the Crisis Center. No further information is ascertained from clients due to the confidential nature of services. 15. Number of Contacts Types of Contacts Call,478 Crisis 62% Walk-ins 3 902 Info.$ Referral 38% Total ,380 SEX AGE Male 55$ Under 18 - 13% Student 19% Female 45% 18 $ over- 87% Non -student - 81% The•Rape Victim Advocacy Program (RVAP) assists victims of sex crimes in any way possible through the Rape Crisis Line. Educational and in- formational services are also provided. A;.total of 64 crisis calls (rapes, attempted rapes, harassments, exhibitionists) were received by the Rape Crisis Line in 1976. During that time, the RVAP Speakers Bureau spoke to over forty different groups E' The RVAP staff states that it is diff (approximately 1,200 in icult to estimate the number of people who were provided information in 1976, as some of the informational resources may be consulted informally at the RVAP office. The staff averages about two or three requests a .. week'for information concerning the number and location of various in- cidents in the Johnson County area. The following client characteristics were given and include all clients served. Percentages are estimated. 'AGE SEX RACE 13 - 18 years - 15% Female -99% White - 85 19 - 24 years - 35% Male - 1 Non-white - 15$% 25 - 35 years - 25% 36 - 59 years - 25% FAMILY INCOME RESIDENCE Iowa City - 75% Under$5,000 - 90% Coralville• -..10% $10,000-$24,999 - 10$ University Heights - 5$ Other Areas/Johnson County - 10% • • 16. Birthright provides material support, counseling, and crisis in- tervention to women who find themselves in an unplanned pregnancy. In 1976, 150 to 200 clients were served by the telephone reassurance and counseling services which Birthright provides. Data on client charac- teristics (all programs) is as follows. All percentages are estimated. AGE SEX RACE 13-18 years -65% Female -95% White- 95% 19-24 years -35S Male - 5% Non-white- 5% 25-35 years -10% RESIDENCE Johnson County - 75% Small Towns- 7.5% Metro Iowa City- 60% Rural Areas- 7.5% Out -Of -County - 25% The Department of Social Services Central Child Abuse Registry in Des Moines provides information, intake, and referral to individuals who report cases of child abuse. Approximately 2,000 families in the state were served in 1976. No information on the number of Johnson County clients is available. The Women's Resource and Action Center provides support groups and counseling, information and referral, and classes and workshops which focus on providing. information and assistance to women. During the 1976-77 University school year, 200 clients were served through the support groups and counseling program. All were women, of whom the great majority (95%) were white. Most were between 25 and 35 years of age. About 64% of the clients served reside in Iowa City. Estimated percentages of client characteristics are shown below. AGE SEX 19-24 years -10% Female -100% 25-35 years -80% 36-59 years -10% RACE White -95% Non-white - 5% RESIDENCE Iowa City -64L Coralville - 8% University Ht. - 8% Small Towns in J.C.-10% Rural Areas in J.C.-10% • • 17. Data on income is not available. Information and referral is provided by phone and through the iVRAC Newsletter. About 2,500 individuals were served by thes resources during the 1976-77 school year. Of this number, about 65% (1,625) were carried over from the previous year. The majority of clients of this program are between the ages of 19 and 35. About 60% reside in Iowa City. Approximately 851 of all clients are female and about 90% are white. Estimated client characteristics are as follows: AGE SEX RESIDENCE 0- 4 years- 5% Female -85% Iowa City -60% 5-12 years- 5% Male -15% Coralville -15% 13-18 years- 5% University Ht. -::5% 19-24 years -30% RACE Small Towns in J.C.-10% 15-35 years -30% Rural Areas in J.C.-10% 36-59 years -20% White -90% 60 and over- 5% Non -white -10% No data on income is available. About 100 individuals participated in classes and workshops offered by WRAC during the 1976-77 school year. All were women, about 90% between 36 and 59 years of age. Percentages on client characteristics (except age) `'•" ; are the same as for the support groups and counseling program. Parents Without Partners provides educational and social opportunities for single parents and their children. No information on clientele has been obtained. Churches and Religious' Organizations provide counseling for a wide range of problems and concerns. Twelve of 20 clergymen who responded to a questionnaire in June, 1977 provided information on the number of cases counseled/sessions provided per year. Eleven of these were Iowa City clergy and one was a Coralville clergyman. An average of 50 sessions/ cases are counseled per year by each of the respondents. Data on the overall ls. makeup of the population counseled is presented below. *Congregation Members 55% **Low-income 31% Non -Members 45% Middle -Income 62% **Youth 14% Upper -Income 7% Young Adults 58% **Metropolitan -Area -Residents 83% Middle Aged 20% Small -Town Residents 11% Elderly 8% Rural Residents 6% *Based on 15 responses **Based on 13 responses Community Pastoral Counseling Service provides direct counseling to clients who need help in resolving marriage and family ,conflicts. From September 21, 1975 thru September 20, 1976, 20 clients were served and 151 hours of counseling were provided. Five clients were carried over from the previous year. The majority of the clients served (60%) 25 to 35 years of age, with the remaining 40% were between the ages of 36 and 59. Half of all clients were male and half female. Most were white. About 55% of the clients reside in Iowa City. Data on client characteristics is on the following page. AGE SEX RACE RESIDENCE 25-35 years -60% Female - 50% White -90% Iowa City 55% 56-59 years -40% Male - 50% Non -white -10% Small Towns in J.C.-45$ Data on income is not available. 0 0 19. SERVICES PROVIDED Counseling services are delivered in a variety of settings. The setting which comes to mind most often is the counseling agency or private practioner where clients voluntarily come to receive assistance from a formally trained counselor, most often a social worker. Other settings in which counseling is delivered are agencies who provide counseling as a major component in their programs: the telephone, or crisis counseling agency, support organizations serving special popu- lation groups, and churches or religious organizations. Agencies or Individuals With Counseling As Their Primary Purpose University Counseling Service - The mission of the University Counseling Service is to facilitate student development at the Univer- sity of Iowa by providing assistance to students and staff in solv- ing problems, making decisions, and applying learning skills in the areas of vocational, academic and personal development. The Counseling Service works with other student service groups in the University in the assessment and redesign of educational environ- ments. The University Counseling Service is a state—sponsored program. The service offers individual and group counseling and structured groups for specific areas and environmental intervention. To be eli- gible for services, clients must be related in some manner to the University. Students have first priority, then student spouses, then staff, then faculty and spouses of the last two categories. Clients' wait for service is usually less than a week. The number of persons on the waiting list is usually about two. 0 0 20. Referrals to the University Counseling Service come from other University agencies. The University Counseling Service refers to the Community Mental Health Center or to other University agencies. The Counseling Services engage in joint planning for student services with the Deans and Directors of other student services. Lutheran Social Services (LSS) purpose is to provide professional social work services to families, individuals, couples and groups re- questing one of the several therapeutic and educational services offered by the agency. There are no eligibility criteria for counseling assistance. Fees charged are based on the clients ability to pay. There is a 30-45 day waiting list due to insufficiency of staff time to handle the local case load. Funding for the service comes from Lutheran churches and the United Way. LSS receives referrals for counseling from the Community Mental Health Center (when demand for service exceeds supply), churches (when more trained or formal counseling is desired or needed), Johnson County Probation Office (for family counseling), and the Department of Social Services (when clients are ineligible for their service). LSS refers on a regular basis to the Department of Social Services (for financial assistance), and to support groups or the Community Mental Health Center (for group counseling). Counselors in Private Practice - Social workers, who to the best of our knowledge provided counseling in a private practice setting, were surveyed. A total of eight responses were received; six indicat- ing that they did not have private practice clients, and two indicating that they did. 0 0 21. One social worker, who accepts only a few clients, works with individual, marriage and family problems. An emphasis is placed on interactional and communication skills. Goal -oriented, time-limited sessions are used with reevaluation after six sessions. Contracting as part of the treatment procedures is also used. Marital problems are those most frequently encountered. Service is provided immedi- ately with a maximum of a one-week waiting period. No sliding -fee scale is used. When referrals are required, University Counseling Service, University Psychology Clinic, and the Mental Health Center are recommended. No referrals are received from other agencies. The other respondent to the survey is a full time private prac- tice counselor who does both family and individual counseling. No particular "school" of counseling is followed, but the respondent notes that the interactions of people are of particular concern. The most common problems encountered are, again, marital. The occasion to refer clients has not arisen. Agencies Who Provide Counseling As A Major Component Of Their Programs The Department of Social Services provides counseling as an integral part of the unit for protective services for children. As well as its many other programs, the protective services unit of the Johnson County Department of Social Services attempts to alleviate neglect or abuse of children. The goal of the program is for the protection of children and the betterment of family functioning. The Department of Social Services is mandated to provide this service. The methods of service delivery are as follows: investigations, in-home treatment, case work, and referral to other agencies. There are no eligibility guidelines for this program. Funding for this pro- gram is provided through Title XX. This program receives referrals from 0 C 0 22. the following: University Hospitals, Mercy Hospital, and various doctors. This program makes referrals to the following: Familes, Inc., Dr. Owen Duffy,. Crisis Center, and Lutheran Social Services. This program does joint planning with the Probation Office and County Attorney (on juve- nile matters). There is no waiting list for this program. Many alternatives are available to the protective service unit for working with the troubled family beyond assistance which is pro- vided directly by the social workers in the unit. Referral to another counseling agency or private practitioner, or to the Department of So- cial Services family treatment team; referral to Families, Inc. for intensive in-home treatment; provision of temporary or longer-term foster care; referral to group homes, residential facilities, or supervised independent living situations. Regardless of the alterna- tive chosen, DSS continues to monitor the case and provide social work counseling when this is not available through the referral agency. The in-home treatment unit supervises the case unless an out -of -home placement is made for a duration of more than 90 days, at which time the out -of -home unit assumes responsibility. Following is a descrip- tion of the alternatives available and the role which counseling plays in it. Intensive In-home Treatment is used with severely dysfunctional families who have a number of problems. It is used as an alternative to out -of -home placement for one or more family members. Case workers can work directly with the family up to several hours a day. 0 • 23. Service can be provided by the DSS in-home treatment unit or a referral of the case can be made to Families, Inc. All referrals to Families, Inc. must be made by DSS. No fees are charged for the service and funding is through Title XX (DSS). Foster Home Care provides a substitute family -life experience in an agency -supervised home to children who need care for a temporary or extended time -period during which the normal family environment is either non-existant or greatly hampered for social, emotional or physical reasons. Children may be placed in foster care either voluntarily or in- voluntarily. Voluntary placement is made through agreement between the parents and DSS. In cases of involuntary placement the custody of the child is transferred, through court order, first to the'court and subsequently to the DSS. In both types of placement, DSS provides the gamut of available services which are necessary to alleviate prob- lems. Both the DSS and Lutheran Social Services have foster care programs which attempt to alleviate dysfunctional family life and, perhaps, physical or emotional abuse or neglect. Case workers provide assistance to the foster family and supervision of the person placed in foster care to assure that total care is provided and all basic needs are met. Case workers work with the client's school and with the natural family during foster home placement and provide follow-up readjustment assistance to the individual in his/her natural family after the termination of foster placement. The extent to which each of these program elements is provided is dependent upon the particular needs of the child and his/her family. 24. If the child is placed in a DSS foster home, DSS staff provide the case work. If the case is referred to Lutheran Social Services, they provide the case work. Eligibility for the service at either agency is dependent upon the nature of the circumstances confronting the child. All funding for programs at both agencies is provided through Title XX (DSS). Lutheran Social Services states that it plans jointly with DSS for foster care. Group Home Care for Children is another alternative for dealing with severely dysfunctioning families. It is a program designed to provide a comprehensive treatment -oriented living experience in an agency -owned or operated facility for children who, for some reason, are unable to adjust in their own or foster home, and who are not suited for placement in an institutional setting. The program is geared to the specific needs of the child and to his or her eventual return to his/her own home and community as soon as their personal and social adjustment and development permit. Program elements in- clude: study and evaluation of the child and his/her needs; supervis- ion of the person placed in group homes to the end that total care and treatment are provided and all basic human needs are met; work with the family during group home placement, as needed; and follow-up readjustment assistance to the individual and his/her family after termination of the group home placement. In Johnson County there are three group home facilities. Youth Homes, Inc. has a boys' and a girls' group home and Lutheran Social Services has a boys' group home (Coffelt Place). Youth Homes, Inc., operates two group homes: one for girls and one for boys. Girls' Group Home serves adolescent girls in crisis 0 (abuse, neglect, delinquent, family conflict) who cannot live at home or in a foster home. This program provides housing counseling and vocational and social skills. Personal and occupational skill devel- opment are also program elements. Clients must be female, from 14 to 17 years of age, and be referred by the Department of Social Services. Fees are based on the client's ability to pay. (This assessment is made by the Department of Social Services.) Wait for service ranges from zero to 30 days. Seventy percent of the funding comes from the Iowa Department of Social Services: 42 percent through maintenance funds (state foster care funds) and 28 percent through service funds (Title XX). Thirty percent of the funding is provided by the Johnson County Board of Supervisors. Referrals to this program are received from the Iowa Department of Social Services, Johnson County Probation Office, and United Action for Youth. Referrals are commonly made to the following: schools, `.. Psychiatric Hospital, Mayor's Youth Employment Program, Owen Duffy (psychologist in private practice), and the Community Mental Health Center. Joint planning for the program is done with the Mid -Eastern Iowa Crime Commission, Johnson County Regional Planning Commission, the Iowa Group Home Association, and Child Care Administrators of Iowa. Youth Homes, Inc. - Boys' Group Home - This program serves ado- lescent boys in crisis (abuse, neglect, delinquent, family conflict) who cannot live at home or in a foster home. The goal of the program Js to aid the resident in developing the necessary living skills to return home, go to an alternative living situation, or go to indepen- dent living. This program provides housing, counseling, assistance 26. with school and job, and assistance with personal and occupational skills development. The eligibility requirements are the same as those for the Girls' Group Home, with the exception of that for sex. The fee schedule is also the same as that for the Girls' Group Home. Re- ferrals made by both programs are the same. An initial grant for this program was provided by LEAA (in the amount of $44,515.70) to be expended for staff, equipment, and program development. The grant requires a 10% match, which has been provided by the Johnson County Board of Supervisors. Funding for 1977 was pro- vided by the following: 1) LEAA Grant (90% federal/10% Johnson County Board of Supervisors). . . . . . . . . . . . . . 44% 2) Johnson County Board of Supervisors . . . . . . . 17.5% 3) Iowa Department of Social Services . . . . . . . . 38.5% The nature of services provided by this program is influenced by the Iowa Department of Social Services through contracting, the Johnson County Board of Supervisors through contracting, and the Iowa Crime Com- mission through grant funding. Lutheran Social Services Boys' Group Home-Coffelt Place - This program provides a group living situation similar to the above mentioned programs. The program provides housing, counseling, assistance with school and finding jobs and social and personal development. The only eligibility requirements are age (14-17 years of age) and sex (male). Funding for Coffelt Place is provided by the Department of Social Ser- vices.(Title XX) which is the only outside agency that has an influence on the nature of the program. Job Service of Iowa and the schools pro - vide services that are utilized by clients on a regular basis. 0 0 0 27. Other agencies providing group home care which are not located in Johnson County, but whose programs are available to Johnson County residents are Hillcrest Family Services and Iowa Childrens' and Family Services. Transition to Independent Living is a program designed for youth aged 17-18 who are mature enough to function on their own with some counseling and supervision. The youth served in this program have pro- gressed through various alternative living situations such as foster care or group home living who, for various reasons, are not able to I. return to their own homes and are deemed ready to be responsible for their own lives. Ultimately, the objective of this program is to assi- milate the necessary social, psychological, emotional, and other skills necessary to successfully live independently. Youth Homes, Inc. provides a transitional program to independent living which includes counseling in the above-mentioned areas. The only ` eligibility criterion for this program is that a youth be between 161 . ''. and 18 years of age. Fees for this program are assessed by the Depart- ment of Social Services and are based on the parent's ability to pay. =•:i; Funding for the program is provided through Title XX (75% federal funds and 15% state funds). Referrals come from the Johnson County Deparment of Social Services, Johnson County Probation Office, and United Action for Youth. The program refers to the following agencies: The Mayor's Youth Employment, United Action for Youth Program, Owen Duffy -private psychologist, the Community Mental Health Center, and the school system. • . 28. Informal "Street Counseling" to Youth United Action for Youth provides a program which includes counsel- ing, guidance, and outreach to youth in informal settings. Counselors and para -professionals meet with youth at places where .the.youth regu- larly congregate. United Action for Youth has as its overall mission the provision of assistance to young people, especially those who are alienated from the traditional approaches to youth service, by iden- tifying their individual needs and opportunities and facilitating the meeting of those needs and the development of opportunities in the best interest of the individual with regard for the community. The outreach program aims at alleviating the problem of juvenile delinquency and related problems through the development of contacts with youth who are experiencing difficulty and through assistance to troubled youth who are identified as being under severe stress which is likely to result in delinquent behavior if not relieved. The out- reach program provides both direct and indirect services which include street counseling, crisis intervention, information referral and follow-up, and planned leisure recreation activities. Services are available from 8:30-4:30 Monday thru Friday, 12 months of the year. The clients of the program must be approximately 18 or under. No fees are charged. The services of the outreach program are generally available with- in the day on which contact is made. Tutoring requests usually take 1 to 2 weeks to be matched. Drug seminars and other programs are • • 29. usually planned a month in advance. of the services offered. There is no waiting list for any Referrals to the outreach program are routinely received from Iowa City schools, Johnson County Social Services, Youth Homes, Inc., Iowa City Police Dept., Iowa City Recreation Center, PALS program, and the Crisis Center. All of these are for complementary services. United Action for Youth refers clients to the following on a regular basis: Youth Emergency Shelter (for emergency shelter care -placement must be made through the Dept. of Social Services), Youth Homes, Inc. (for group home placement), Mayor's Youth Employment Program and CETA (for women's health care, Iowa City Free Medical Clinic (for health care). Other agencies which provide services that are used by clients on a regular basis are: Lutheran Social Service, HACAP, Psychiatric Hospital, Community Mental Health Center, Coralville Recreation Cen- 'ter, Goodwill, Career, Development Program, Kirkwood, Mark IV Community _,Center., and Wesley. House. The following influence the nature of services provided by United Action for Youth's outreach program: 1) City of Iowa City (contracting and funding), 2) Johnson County (contracting and funding), 3) United Way (funding), 4) Juvenile Court (referral accountability), and 5) Johnson County Social Services (referral accountability). Joint planning for the program is done through monthly meetings with CEEC, PS 4, and the Iowa City schools. Meetings are also held with Johnson County Social Services about once every two weeks regarding clients and case plans and with Youth Homes, Inc. about once every two weeks regard- ing the same. Monthly meetings are held with United Way. UAY also • 0 30. meets every 60-90 days with Juvenile Probation regarding clients and case plans. Johnson County Social Services, Youth Homes, Inc., Mayor's Youth Employment, and Mark IV Community Center all provide services to young people but do not provide youth outreach. Funding for the agency comes from these sources: Iowa City. . . . . . . . . . 55.8% United Way . . . . . . . . . 6.5% CETA . . . . . . . . . . . . 4.8% LEAA . . . . . . . . . . . . 29.6% State Buy -in and Johnson County also contribute small amounts. 9 0 • � 31. Crisis Intervention Services This service encompasses programs designed to mobilize timely intervention'in the lives of individuals who are experiencing emotional distress or are prone to suicide or some other form of physical self- abuse. This service category also encompasses programs designed to mobilize timely intervention and assistance to come to the rescue of innocent victims of violent crimes, such as rape. The Iowa City Crisis Center provides free, short-term crisis intervention services, counseling, and information and referral. Crisis intervention is available to anyone by phone at all times; walk-in ser- vice is available 15 hours per day. The intervention program immedi- ately meets a client's self -defined need for information or someone to talk with. Staff volunteers undergo a 50 -hour training program which includes education in helping skills and information about community resources. The Crisis Center most frequently refers clients to the following: Free Medical Clinic, University Counseling Service, University Hospital, Community Mental Health Center, and the Emma Goldman Clinic for Women. In addition to these agencies, clients are often referred to the Alco- hol and Family Counseling Center, area physicians, clergy, Psychiatric Hospital, Lutheran Social Service, HERA, employment services, Hawkeye Legal Services, Student Legal Services, police, Protective Association for Tenants, Womens' Resource and Action Center, United Action for Youth, and the Youth Emergency Shelter. Johnson County Social Services' answering service and the Free Medical Clinic and Mental Health Center list the Crisis Center when they are not open for service. About 70 percent of the funding for the 32. Crisis Center comes from the Johnson County Board of Supervisors and about 30 percent from United Way. The Crisis Center also operates a Youth Line which provides an alternative for help to persons under age 18. Trained teenage coun- selors (aged 14-18) provide immediate, confidential, and anonymous crisis intervention under the supervision of staff and experienced adult volunteers. Parents, as well as teenagers, are encouraged to use this service. Youth Line counselors are available from 5:00 p.m. to 10:00 p.m. every day of the year. Referrals to the Youth Line have been made by agencies and fam- ily members and by some school counselors. Individuals also become aware of the service through publicity. The Youth Line refers clients to the previously mentioned agencies. United Action for Youth (which has a similar service), and the Youth Emergency Shelter are the agen- cies to whom clients are most often referred. About 64 percent of the funding for this service comes from the Johnson County Board of Super- visors and 26 percent from United Way. The Rape Victim Advocacy Program has as its first concern the physical and mental wellbeing of victims of rape and other forms of sexual abuse. This involves utilizing workable relationships with law and medical personnel and the County Attorney's office. The program also exists for the purpose of informing the public about the issue of rape and sexual abuse and working toward prevention of such crimes. The goal of the Rape Victim Advocacy program is to assist vic- tims of sex crimes in any way possible. The Rape Crisis Line operates on a 24-hour basis, so that it is possible for a victim to contact someone immediately after an incident has taken place and to receive support and direction concerning the alternatives which are open to him/her. 33. The Rape Victim Advocacy Program provides information and films through its Information Bureau and assists other agencies in setting up similar programs in their communities. The program also has a Speakers Bureau which talks to groups, classes, and organizations about the crime of rape and other forms of sexual abuse. In addition, the staff has done in-service training to sensitize medical and legal pro- fessionals, as well as counselors, teachers, etc., to the need of victims of sex crimes. The Rape Crisis Line is in operation 24 hours a day, 7 days a week. When no one is in the office, emergency advocates take calls from their homes. Clients are referred to the service through pub- licity (25%), by self (25%) and from agencies (25%). Referrals to the Crisis Line are routinely received from Johnson County Social Services, Crisis Center, United Action for Youth, Attorney's offices, police departments, and various church groups and ministers. No fees are charged and there are no eligibility criteria. Emergency service is given immediately. Necessary referrals are made to the following: Mid -Eastern Community Mental Health Center (for extensive or family counseling), Emma Goldman (for V.D. check and pregnancy testing for clients who do not want to see private physicians), private attorneys, Iowa City Police f)ept., Johnson County Sheriff's Dept., Campus Security, etc. The Com- munity Mental Health Center and the Johnson County Attorney's office are -agencies whose services are most frequently used by clients. Services offered by the Rape Victim Advocacy Program are influ- enced by Student Senate (financing), Johnson County Board of Supervisors Exact figures received from agency. 0 0 34. (funding), Vice -President Hubbard, and the WRAC Advisory Board. The program has a joint planning/advisory relationship with University Hospitals, the Iowa City and Coralville Police Departments, and the Johnson County Sheriff's Department. No agencies in the county provide a similar program. Funding for the program comes through University of Iowa Student Senate (12.2%), Johnson County Board of Supervisors (38.1%), City of Iowa City Aid to Agencies (38.1%), Housing and Community Development Assistance - Iowa City (11.4%). Birthright is an agency which serves persons who have unplanned or unwanted pregnancies or difficulties of a personal nature related to a pregnancy. It offers three programs: Family and Individual Support, Emer- gency Income and Material Support, and Mental Health/Counseling and Crisis Intervention. The Birthright office is open three hours a day, five days a week during the University school year. A staff member can be reached at all times through an answering service. Anyone, regardless of race, creed, marital or economic status, who finds herself in an unwanted or un- planned pregnancy may receive assistance. All clients are served directly. No fees are charged. The purpose of Birthright is to provide an atmosphere of comfort, confidentiality, and privacy, to alleviate any anxiety about the client's personal situation, and to help the client clarify the problems, feel- ings involved and alternative ways of coping. Clients are seen on a one-to-one basis. In addition, Birthright provides temporary housing as needed, maternity clothing, baby clothes and furnishings where needed through the Emergency Income and Material Support program. Anonymous pregnancy testing, help in obtaining employment, and transportation related to these needs are also provided. Fifty percent of clients are self-referred and 40 percent are referred through publicity.. Five percent are referred by family and 5 percent from agencies. Referrals are routinely received from other Birthrights, University Hospital,social workers (for help with hous- ing), Emma Goldman Clinic (for girls deciding to continue pregnancy), and the Crisis Center (for supportive services). There is no waiting list. Service is immediate. Referrals are made on a regular basis to these agencies: Johnson County Social Services (for financial aid and state papers), Catholic Charities adoption counseling, and Lutheran Social Services (for adoption counseling). Client is usually accompanied by a volunteer from Birthright. If a client has legal questions a consultation may be arranged with Birthright's legal advisor. In addition, some clients utilize the services of Wesley House for emergency shelter of one to two days in length. Funding for the agency is provided entirely through donations and membership fees. Department of Social Services - Central Child Abuse Registry pro- vides a 24-hour, 7 day a week source of information, intake, and referral for individuals reporting cases of child abuse. All cases of reported child abuse are referred to the County Dept. of Social Services for investigation and follow-up by the protective service unit. Funding for the program is through Title XX (D.S.S.) 0 0 36 . Support Groups Support Groups provide individuals experiencing personal difficulty or stress due to environmental circumstances and other factors an opportunity to share experiences and to receive support and comfort from others experiencing similar difficulties. The Women's Resource and Action Center provides the following services: support groups and counseling, information and referral, and classes and workshops. Programs focus on supportive services, educa- ion, and information for women; there are no eligibility criteria for services, which are open to men as well. Support groups offered by WRAC are: orientation for women new to the community, support and friendship, and common solutions to com- mon problems. Individual counseling appointments focus on values clarification and decision-making. There are no eligibility criteria and no fees are charged for service. Service is available from 9-9 (9-5 during the summer), Monday through Friday, 12 months of the year. The Center is accessible to handicapped persons. Seventy percent of those who utilize counseling and support group services are self-referred. Twenty percent are referred through pub- licity and 10 percent are referred from agencies. Clients may wait up to six weeks for support groups (for previously scheduled meetings) and up to two weeks for individual counseling. There . is no waiting list. WRAC offers referrals for telephone and walk-in clients to agencies and individuals, etc. in the areas of counseling, medical care, legal counsel,legislation, child care, divorce, welfare, etc. Information is also distributed in the WRAC newsletter. There are no client eligibility criteria and no fees are charged. I & R is available for 9-9 (9-5 during the summer: Monday - Friday, 12 months of the year. 0 0 37. Sixty percent of those who contact WRAC for I $ R are self-referred, 20 percent are referred through publicity, and 20 percent are referred by other agencies. Information on the agencies which refer clients to WRAC's I $ R service is unavailable. Those agencies/individuals to whom clients are referred by WRAC on a regular basis are: 1) Hawkeye Legal Aid or pri- vate attorneys (for legal advice which WRAC can't give); 2) Community Mental Health Center or private counselors (when demand exceeds supply at WRAC, or when more concentrated or specialized counseling is de- sired); 3) University Hospitals or Emma Goldman Clinic (for medical care); 4) miscellaneous other services. Information and referral ser- vice is often immediate; in some cases it may take up to one week to procure the necessary information to assist a client. There is no waiting list. The University of Iowa, City of Iowa City, and Johnson County Board of Supervisors have influence on the nature of I $ R services provided by WRAC. The center has no joint planning/advisory relationship with anyone for this program. The Crisis Center provides a similar service, but for more generalized, less specialized areas. Remedial programs such as Assertive Behavior Training, programs on financial management, etc. for women in transition, and legal work- shops. Fees are sometimes charged; all fees are related to client's ability to pay. Fifty percent of those who participate in classes or workshops are self-referred and 50 percent are referred through publicity. It is mentioned, in addition, that referrals are received from Johnson County Social Services, the Mental Health Center, and the Crisis Center. I. Funding for WRAC comes through the University of Iowa and the Fed- eral Work Study program. • • 38. Parents Without Partners is an educational and social club for single parents and children which meets once a month. Single par- ents, widowed, divorced, or unmarried are eligible for membership. The initial membership fee is $12.50. Other Counseling Resources Churches and religious organizations provide counseling to a num- ber of people in Johnson County. Clergymen are often the first con- tact for the individual or family seeking counseling for emotional problems. All churches in Johnson County were asked to complete a question- naire, half of which dealt with counseling services provided by clergymen. Twenty of the sixty churches responded, seventeen indicating that they provide counseling. Counseling is provided as previously men- tioned in the Problem Description section of this profile, for proglems in these areas: marriage, depression, career, pre -marital, male-female relationships, family/parent-child, life adjustment/identity, academic/ occupational choice, spiritual/theological, alcohol/drugs, problem pregnancy, transients, and health crisis/death. The number of sessions per counselee(s) varies from one to about 20. Most of the pastors provide counseling of one to six sessions in duration and refer to professional, more specialized counselors if long-term counseling is required. This information was provided by 11 of the 20 respondents. Referrals for counseling are received with the greatest frequency from the following sources (information provided by 19 of 20 respondents): Friends Previously Counseled/Congregation Members 8 Other Pastors 7 Crisis Center 3 Seldom/Never Received 6 n 0 + .39. Other sources of referral mentioned by only one respondent each are: Lutheran Social Service Oakdale Johnson County Social Services City of Iowa City Wesley House Doctors Community Mental Health Social Workers Gloria Dei Lutheran Church School Officials U. of I. School of Nursing Parents University Hospital Most pastors make referrals for long-term or specialized (e.g., alcohol/drug problems, problems of transients, financial difficulties) counseling needs (information provided by 18 of 20 respondents). Such referrals are most often made to: Crisis Center . . . . . . . . . . . . . . 6 WesleyHouse . . . . . . . . . . . . . . 4 Community Mental Health . . . 4 MECCA . . . . . . . . . . . . . . . . . . 4 Private Psychologist/Psychiatrist . . . . 4 Psychiatric Hospital. . . . . . . . . . . 3 Johnson County Social Services. . . . . . 3 U. of I. Counseling Service . . . . . . . 2 Other Clergy . . . . . . . . . . . . . . . 2 Do Not Refer . . . . . . . . . . . . ... . 3 "Referrals are also made to the following resources (each mentioned by only one respondent): Christian Marriage and Family Counseling (Cedar Rapids) Community Pastoral Counseling Number Suggested by Iowa City Religious Leaders Association HACAP Family'Services Local Professional Counselor Agencies Specializing in Counseling for Problem Pregnancies Agencies Dealing in Financial Assistance/Counseling All of those pastors who provide counseling (18) do not regularly charge for their services. Two of them indicated that there may be a IIF; •, charge for books/materials involved. One of the pastors sometimes charges for counseling, based on ability to pay and one charges only 0 0 40. for long-term (more than 6 or so sessions) counseling. One pastor charges a $50 fee to non -congregation members for premarital counseling. The Community Pastoral Counseling Service also provides counsel- ing to individuals in Johnson County. The mission of the Community Pastoral Counseling Service is to provide a professional pastoral counseling resource for the community and to develop and encourage educational programs in pastoral counsel- ing. The Pastoral Counseling Service provides direct counseling with clients who need help in resolving marriage and family conflicts. Appointments are arranged by client and counselor. In addition to the Counseling Service's own office, a counseling office is available at Wesley House. Fees charged for the service are based on ability to pay. Churches provide some financial support for the service which can be used if needed to pay all or part of the fee. Seventy percent of clients are obtained through referral from agencies; 20 percent are self-referred, and 10 percent are referred through publicity. There is usually about a one week wait for service. Referrals to the Pastoral Counseling Service are made on a regular basis by local church pastors who feel they are not qualified to handle cer- tain cases. Referrals are not made by the Counseling Service on a regular basis. Similar services are provided by Lutheran Counseling Service and by local pastors. The Pastoral Counseling Service does not have a joint planning/advisory relationship with any other organization on a regular basis. Funding for the agency is provided by the following churches: First Baptist Church Gloria Dei Lutheran Church First Congregational Church First United Methodist Church, 0 0 41. COUNSELING MAJOR UNMET NEEDS/PROBLEMS IN THE SERVICE DELIVERY SYSTEM Several problems were identified in the course of the study: lack of cooperation and coordination among agencies providing counsel- ing services; ineffectiveness of court-ordered conciliation services when mandated as part of dissolution proceedings; long waiting lists for those counseling agencies offering sliding fee scales; an increase in the incidence of single parents needing assistance; and a shortage of certain specific services. In addition to these problem areas, several other suggestions were made to improve the delivery system. Inadequate cooperation and coordination among agencies provid- ing services was the most frequently mentioned problem. This has resulted in inconsistencies in the way youth with multiple problems are handled. Sometimes an agency working with a family may not be able to get information which would assist in the treatment of that family from another agency. Delays in the provision of service, mis- understandings or disagreements regarding service provision may occur when two or more agencies are involved with the same client. Action taken by one agency, without the involvement of other relevant agencies, may result in inconsistent treatment of clients and in poor relations among agencies. Conciliation services are mandated in those dissolution (divorce) cases which are contested by either party. A court-ordered referral to a counseling agency is given to the couple and they must attend before the dissolution is granted. Attorneys in Johnson County were asked how they viewed court - Ordered conciliation. The response was overwhelmingly negative. Only two of the seventeen attorneys responding to the question saw • any value to conciliation • Their responses were: 42. - "waste of time, money and energy, but often helps requesting party feel comfortable with dissolution." "generally ineffective unless one of the parties deep down wants reconciliation and won't admit it." Counselors with whom we spoke also felt that court-ordered conciliation was ineffective and frequently used only as a stall tactic by one of the parties. Generally, it can be concluded that court- ordered conciliation is a waste of community resources. Shortage of personnel at some agencies providing services on a sliding fee scale is a problem most directly exemplified by the long waiting lists of two of the major providers of family and individual counseling. The wait for service at Lutheran Social Service averages 30 to 45 days, resulting in an attrition rate of about 40 percent. The Com- munity Mental Health Center, which also provides a great deal of family and individual counseling, also has a three to six week waiting period for service. (Note: The Center's outpatient services for treatment of mental illness are dealt, with in the Mental Health Pro- file.) An individual or family facing a real or perceived crisis most often feels that counseling is needed immediately. Often, it has ,taken a great deal of courage to make the contact for counseling. To be told that a wait of several weeks is required before a counselor can be seen may discourage the person from seeking help. Psychiatric Hospital makes outpatient counseling available on a sliding -fee scale and has no waiting list select an agency is unknown. The basis upon which clients r 1 U • 43. University Counseling Service can serve only students and staff at the University of Iowa. They too, however, have stated that there is a shortage of longer-term treatment (beyond 8-12 sessions) avail- able to staff requiring such therapy. No insurance or third -party payment is available for such services. An increase in the number of single parents who are seeking assistance is reported by the Crisis Center, the Women's Resource and Action Center, and the Department of Social Services. No judgement is made on the ability of counseling agencies to deal with their pro- blems. However, it may be assumed that wider publicity of and acces- sibility to helping resources would be advisable. A need for more comparable and valid data collection among agencies, and a central register for non -confidential data was cited by several agencies as well as the Subcommittee. The Subcommittee also felt that a system of evaluation of agency effort should be deve- loped and a greater emphasis placed on accountability. Other Problems Cited by Agencies and Individuals A shortage of specific services was mentioned by several agencies. Listed below are the services and source identifying the problem. 1. More foster homes, particularly for adolescents (DDS) 2. Alternative living arrangments, particularly for supervised independent living (DDS) 3. More appropriate alternative school settings for youth, both in variety and capacity (UAY and Youth Homes, Inc.) 4. Additional shelter for runaways. The Youth Emergency Shelter is often full and has limitations as a result of restrictions and placement requirements made by DDS (UAY) S. Need for men's supportive services dealing with aging, voca- tional stress, marital difficulties and coping with emotions (clergymen) • 44. 6. Lack of continuity in working with troubled youth after they reach the age of 18. Currently no services are avail- able for children over 18, yet they may soon be starting families of their own (DDS and Families, Inc.) 7. Insufficient agency/individual resources to meet the needs of women in transition, e.g., women returning to school or work, divorcing, single parenting (WRAC) 8. An interim step should be provided between institutionaliza- tion and home care. This may be a two to three day "atten- tion -getting" period for adolescent who may be able to avoid institutionalization (Families, Inc.) Other suggestions for improving the delivery system were made by individuals and organizations who participated in the study. They are: 1. A need for guidelines for community standards or "norms" of behavior; a picture of what the "normal" family is like (Families, Inc.) 2. Criteria.on when a child needs to be removed from the home should be developed (Families, Inc.) 1;, ■ IyI�{ .g iia1 ii1�. ��� �.1•' : JY HUMAN SERVICES STUDY MENTAL HEALTH PROFILE October 7, 1977 Mental Health/Chemical Dependency Sub -Committee Members: Verne Kelley - Chairman Gladys Benz Graham Dameron David Henson Paul Huston Staff: Connie Echternach and Jill Ferguson Johnson County Regional Planning Commission 22h South Dubuque Street Iowa City, IA 52240 11056 TABLE OF CONTENTS MENTAL HEALTH GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . . 1 Service elements . . . . . . . . . . . . . . . . . . . . . 1 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . . 1 Definition of mental health. . . . . . . . 1 Statistics on number of mentally distressed/ typesof distress . . . . . . . . . . . . . . . . . . . . 2 POPULATION SERVED . . . . . . . . . . . . . . . . . . . . . . 5 Mid -eastern Iowa Community Mental Health Center. . . . . . 6 University of Iowa Hospitals and Clinics - Psychiatric Hospital . . . . . . . . . . . . . . . . 7 Mount Pleasant Mental Health Institute . . . . . . . . . . 7 Veterans' Administration Hospital . . . . . . . . . . . . . 8 HERA, Feminist Psychotherapy . . . . . . . . . . . . . 8 Research and Training Clinic - Department of Psychology . . . . . . . . . . . . . . . . . . . . . . 8 Mercy Hospital . . . . . . . . . . . . 8 Hillcrest Family Services' Iowa City Residence for Women. .. . . . . . . 9 Psychiatrists and psychologists in private practice. . . . 9 Recovery, Inc. . . . . . . . . . . . . . . . 10 Iowa City Crisis Intervention Center . . . . . . . . . . . 11 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . 11 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . . 13 Inpatient psychiatric care . . . . . . . . . . . . . . . . 13 Psychiatric Hospital . . . . . . . . . . . 13 Mount Pleasant Mental Health Institute . . . . . . . . . 15 Veterans' Administration Hospital. . . . . . . . . . . . 15 Mercy Hospital . . . . . . . . . . . . . . . . . . . . . 15 Aftercare. . . . . . . . . . . . . . . . . 16 .Community Mental Health Center . . . . . . . . . . . . . 16 Patient Advocate . . . . . . . . . . . . . . . . . . . . . 16 Outpatient psychiatric care . . . . . . . . . . . . . . . . 17 Community Mental Health Center . . . . . . . . . 17 Mount Pleasant Mental Health Institute . . . . . . . . . 18 Research and Training Clinic - Department of Psychology. . . . . . . . . . . . . . . . . 18 HERA, Feminist Psychotherapy .. . . . . . . . . . 19 Private psychologista.and psychiatrists. . . . . . . . . 20 SERVICES PROVIDED (Continued) Partial Hospitalization/intermediate care: Psychiatric Hospital . . • : : , , Families, Inc. . . . . • Emergency psychiatric care . . • : : : : : : : : . . . . . Psychiatric Hospital . • • • Mercy Hospital , . . • • • Veterans' Administration Hospital. Mount Pleasant Mental Health Institute . . Iowa City Crisis Center. . . . . . . • • Community Mental Health Center . . . • Residential treatment of the emotionally distressed: Orchard Place. . . . . . . . . Transitional residential care of persons recovering from mental illness . . . . . . . . . . . . . . . Hillcrest Family Services - Iowa City Residence for Women. . . . . . . . • • • Maintenance services . . . . . . . . . . • ; ; Johnson County Care Facility . • • • • . Iowa Veterans' Home. . . . . . . . Support groups. . . . . • : : : . . . . . . . . . . Recovery, . • • • ' ' ' Prevention services. . • • ' ' ' ' ' .. .... . Community Mental Health Center . • • Mental Health Association of Iowa. . • • AdMental Health Association of Iowa. UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY . • • • • • ' Lack of common data base and outcome measures. . . . • Inability to pay for outpatient services/shortage of sliding -fee scale availability. Lack of comparable and valid data collection and lack of outcome measures . . . Inadequate cooperation and consultation among service providers in mental health delivery system . Client groups disproportionately represented in agency caseloads . Other problems cited by agencies or individuals. APPENDIX 1 --Emergency Admissions. . . • . , • , • APPENDIX 2 --Outpatient Services . . . . . . . . • • APPENDIX 3 --Services Available. . . . . . . . • . 22 22 22 23 23 23 23 23 23 23 23 24 25 25 27 27 27 28 28 28 . 29 29 29 29 . 30 . 30 . . . 30 31 .31 . . 32 . 32 33 37 37 MENTAL HEALTH 0 • GOAL The goal of mental health services is to reduce the indidence and severity of emotional and mental disturbance and to promote and maintain mental health in Johnson County SERVICE AREA DESCRIPTION The Mental Health Treatment Service encompasses a constellation of diagnostic and therapeutic programs designed to help the men- tally ill in a variety of settings which include the services of psychiatrists, psychologists, and psychiatric nurses and social workers. Service elements include: inpatient psychiatric care, out- patient psychiatric care, aftercare, partial hospitalization for psychiatric care, emergency psychiatric care, residential treat- ment of the emotionally disturbed, transitional residential care of persons recovering from mental illness, maintenance, preven- tion, and support groups. PROBLEM DESCRIPTION Mental health can loosely be defined as the general well-being of a person - his mind and emotions. A 1971 Mental Health Associa- tion publication defines a mentally healthy individual as "one who feels comfortable about himself, feels right about other people and is able to meet the demands of life." An expanded definition ascribes certain characteristics to a mentally healthy individual: Regarding himself,a mentally healthy person is one who can usually cope with his emotions: fear, anger, love, jealousy, guilt or worry; can take life's disappointments in stride; has self-respect and neither underestimates nor overestimates his abilities; and feels able to deal with most situations that come his way. Regarding his relationships with others, a mentally healthy person is able to give love; expects to like and trust others and takes it for granted that others will like and trust him; does not push people around, nor does he allow himself to be pushed around; and is able to establish persona] relationships that are satisfying and lasting. 2. 0 Regarding his ability to meet the demands of life, the mentally healthy individual is one who, if possible, does something about his problems as they arise; accepts his responsibilities; wel- comes new experiences and new ideas; uses his natural capacities; is able to think for himself and make his own decisions; puts his best efforts into what he does and gets satisfaction out of doing it. A surprising number of ,neople, h-owever, lack these characteristics to the point that their functioning as individuals in society is impaired. These can be called to some extent mentally ill. According to another Mental Health Association publication, "One out of ten people in the United States have some form of mental illness, ranging from mild to severe, that would benefit from professional help. Twenty-one million families have someone in their immediate family affected by mental illness that is, more than one in four." The publication also stated that children suffer from mental illness in the same proportion as adults, 3t have severe emotional problems and another 8% have less se- vere problems but are still unable to function normally. Only one person in 35 is receiving treatment for mental or emo- tional problems however. This is less than one third of those needing it, according to the Mental Health Association. The Hoover Health Council and the Johnson County Health Council conducted a health survey of Johnson County residents in 1973-74. Of the 244 responses 33, or 13.5$ indicated that they had had a nervous condition. When asked what it was, the following responses were given: Nervous stomach 16 44.4% Menstrual Disorders 5 13.9% Headaches 3 8.3% Shell Shock 3 8.3% Menopausal Depression 2 5.6% Severe Depression 2 5.60 Nervous Breakdown 2 5.6% Raising Big Family 2 5.6% Polyneuritis 1 2.7% 3. • When asked if they were taking any kind of medicine or pills for their nerves, 5.7% or 14 individuals, responded that they did, 56.2% or 137 said they did not, 93 individuals or 38.1% did not respond to this question. The survey participants were also asked if they or anyone in their household in the last year had been so mentally distressed that they or that person had desired the help of a mental health counselor. Seven percent, or 17 people had, while 93% or 137 had not. Of those who desired such help, 12 or 70% had found help. Eighty-three percent (10) were satisfied while 8.3% (1) were not and 8.3% (1) did not kncw. Individuals contacting the Mental Health Center and the Crisis Center seek help for a variety of problems. Listed below are the number of individuals presenting particular problems to these two agencies. _ PROBLEM Marital Family Relationships Psychosis Depression Identity Anxiety Anti -Social Behavior Post-Marital/Divorce Peer Relationships School Performance Sexual Physical Functioning Suicidal Obsessions -Compulsions Pre -Marital Alcohol Abuse Drug Abuse Mental Retardation Interpersonal Loneliness Financial/Employment Medical Housing Pregnancy/Abortion Mental Health Center 211 151 72 68 66 44 29 26 15 12 18 11 6 7 7 2 2 2 Y Crisis' Center 160 387 372 146 160 203 126 154 212 597 449 365 308 240 151 126 T= Attorneys in Johnson County were surveyed to gain their opinions on mental health problems contributing to marriage dissolutions. Ten attorneys of the 22 responding saw it as a contributing factor in an average of 20% of the cases they saw. The attorneys were also asked about the relationship of mental illness to spouse abuse. The eight attorneys who saw a connection thought it was a contributing factor in an average of 64% of the cases. Seven attorneys also responded that an average of 87% of child abuse cases, with which they are familiar, involve mental health problems. School personnel in Johnson County were also surveyed to ascertain their opinions on problems facing youth. Sixty percent, or 24 of 42 people surveyed, felt that emotional problems were increasing among young people. Twenty percent or 8, of the school personnel felt that identity problems were increasing, while 27.5% or 11, saw disruptive behavior becoming more of a problem. In the area of adequacy of help for mental health problems, 10% or 4 people, felt that services were good, while 45% or 18, felt they were satisfactory and 1S% or 6 said that they were in need of improvement. Clergy in Johnson County were asked about trends they saw in the course of their work in counseling with people. They mental health related trends which they identified were: -More and more persons needing release from pressured lives -More marital and family problems and -More .cases of depression and unfulfilled expectations. POPULATION SERVED Information on the number of individuals receiving mental health treatment services is derived solely from data provided by agencies. Since the distinction of the client who is mentally ill and requires. Mental health treatment, versus the client who has difficulty dealing with stressful situations in his life and therefore requires "Counseling", is often unclear, the service population for this area is difficult to assess. Agencies, such as the Mental Health Center, whose primary pur- pose is mental health treatment, also do family therapy. Agencies, such as Lutheran Social Services, with a primary thrust of counseling, also find themselves treating people who could be called mentally ill. Undoubtedly, psychiatrists in private practice, too, see individuals who would not be diagnosed as being mentally ill. Funding sources are the prime determinant for labeling an agency or practitioner as a mental health treatment program. This has been found to be true particularly when insurance plans cover treatment given by psychia- trists, but not by a counseling service, even though the individual may not require psychiatric treatment. The individual, when given the choice of paying out of pocket for counseling or having treatment given by a psychiatrists reimbursed through insurance will opt for the psychia- trists. Diagnoses of clients were not generally available to us from agencies, consequently it is difficult to ascertain the number of indivi- duals who are clinically mentally ill currently in treatment through all agencies. In short, the service population receiving mental health services will necessarily be imprecise and open to other interpretations. 1Ve will deal in this profile with only those agencies who have the treatement of 0 6. mental illness as a primary thrust. Those agencies whose major focus is counseling will be dealt with in the Family and Individual Counseling profile. The agencies and programs provided in that grouping should be considered as important supportive services to the mental health delivery system. The Mideastern Iowa Community Mental Health Center reported that from July 1, 1975 to June 30, 1976, 724 individuals were served. 400 were new clients served by the center's outpatient services and 324 clients were carried over'from fiscal year 1974-75. The clients had the following characteristics: AGE 0.3% are 0-4 years old 43.5% are 25-35 years old 2.81 are 5-12 years old 26.8% are 36-59 years old 5.2% are 13-18 years old 2.6% are 60 and over 18.8% are 19-24 years old SEX 40% were male 60% were female RACE 99% were white 1% were non-white FAMILY INCOME. 15% - less than $5,000 45% - $5,000 to $9,999 30% - $10,000 to $24,999 10% - $25,000 and over Eighty percent of Johnson County clients reside in the Iowa City metro- politan area, 10% in small towns, and 10% in rural areas. In fiscal year 1977 (July 11 1976 - June 30, 1977), 749 individuals in Johnson County were served by the Mental Health Center, 455 of which were new clients and 294 carried over from the previous year. 37.6 percent of the clients were male; 62.3 percent were female. • 7. The age breakdown was as follows:. AGE 8 0- 4 1 5-12 6.1 13-17 4.7 18-24 17.1 25-34 44.2 35-59 16.8 60 and over 1.8 No income or residence data was available for 1976-77 clients. University of Iowa Hospitals and Clinics - Psychiatric Hospital served 172 Johnson County.residents as inpatients in fiscal 1977. Ninety- eight were admitted for the first time, while 74 were re -admissions. During that same time period, 2,704 outpatient visits involving Johnson County residents were recorded. The actual number of Johnson County pat- ients was not available, however, an estimate of approximately 3 visits per patient was made. It was also estimated that approximately half of all patients,.both inpatients and outpatients, seen at Psych Hospital were from Johnson County. During 1976-1977, 2100 total patients were seen. If the 50 percent figure is accurate, about 1050 Johnson County patients were served by Psych Hospital in the last year. No specific client characteristics were available for Johnson County residents, but it was estimated that 40 percent of the clients were male, 60 percent female. About 98 percent of the patients were white. Mount Pleasant Mental Health Institute served one outpatient in fiscal 1976 and 31 new inpatients and 15 carried over from the previous year. The outpatient was a white male in the 19=24 bracket. The 46 inpatients had the following characteristics: Age Sex Race 198 428 Male 100% White 588 Female 13-18 years 138 19-24 years 138 25-35 years 36% 36-59 years 198 60 and over s. The Veterans Ad -mi 'stration Hospital psychiis ward serves Johnson County residen s, however, no patient count was available since they do not keep statistics by county. HERA, Feminist Psychotherapy served a total of 433 Johnson County clients in the time period between August 1, 1977 and July 30, 1976. Two -hundred and eighteen in group sessions and 151 in individual sessions were served for -the first time: Sixty-four additional clients were carried over from the previous year. The agency estimated that their client had the following charac- teristics: AGE 15% - 19-24 Sex Race 75% - 25-35 years 50% Male 98% White 10t - 36-59 years 50% Female 2% Non-white 16 - 60 and over INCOME 30% 19-24 30% - Less than $5,000 65$ - $5,000 - $9,999 St - $10,000 - $24,999 SEX 80% - Female 20% - Male RESIDENCE 871 - Metropolitan Area 13% - Small Cities The Research and Training Clinic, Department of Psychology pro- vide outpatient counseling to Johnson County residents as part of its training of clinical psychology graduate students. 83 new clients were served during the June 1, 1977 to May 31, 1977 period. Approximately 30 clients were carried over from the previous year. It was estimated that their clients had the following characteristics: No estimates were given regarding income or residency. Mercy Hospital in Iowa City had 206 patients with a psychiatric diagnosis in the last fiscal year. No breakdown was given on the num- ber of Johnson County residents was included in that total. However, about 43% of all hospital admissions are from Johnson County. Age Sex Race 1% 0-4 years 50% Male 98% White 20% 5-12 years 50% Female 2% Non-white 'S% 13-18 years 30% 19-24 years 30% 25-35 years 14% 36-59 No estimates were given regarding income or residency. Mercy Hospital in Iowa City had 206 patients with a psychiatric diagnosis in the last fiscal year. No breakdown was given on the num- ber of Johnson County residents was included in that total. However, about 43% of all hospital admissions are from Johnson County. 0 0 V Hillcrest Family Services, Iowa City Residence for Women provides a halfway house program for women who have a history of mental illness/ hospitalization. The residence was opened in November of 1976 and served four women between then and May 1977. All of their clients are white women from the Iowa City metropolitan area with incomes 'of less than $5,000 per year. Three of the women (75%) are between the ages of 25 and 35. One (25%) is in the 36-59 age group. Psychiatrists and psychologists in private practice also serve Johnson County residents with mental health problems. All practitioners who, to the best of our knowledge, serve clients in private practice were surveyed. Two psychiatrists and two psychologists returned question- naires indicating that they had no private practice. One psychiatrist and two psychologists returned questionnaires indicating that they did indeed have private practice clients. Only the psychiatrist gave the number of clients who were served; the psychologists did not give that infor- mation. The psychiatrist estimated that his 60 clients had the following characteristics: Age 12% - 13-18 years 25% - 19-24 years 25% - 25-35 years Sex 20% Male 80% Female 25% - 36-59 years 12% - 60 and over Income 10% - Less than $5,000 5% - $5,000 - $9,999 80% - $10,000 $24,999 5% - $25,000 and over 801 of his clients came from Iowa City; the remaining 20% from small cities in Johnson County. • • 10. The psychologists,.while they did not indicate the number of clients being seen, did provide information on client characteristics based on estimates of their case load. Both indicated that about 65% of their clients are in the 25 - 35 age group. One saw•the remain- ing clients falling primarily below that age group, the other over that age. Income levels varied more significantly, however, Given below are the percentages given for each income level: Percent Income Psyc ologist A Psychologist B 25% 5% Less than $5,000 45% 10% $ 5,000 - $9,999 25% 80% $10.000 -$24,999 5% 5% $25,000 and over Une psychologist stated that most of the clients came from Iowa City and Coralville; the other did not make an estimate. Recovery, Inc., a self help - peer counseling group, served approximately 23 Johnson County clients in the period of time between Apri> 1976 and April, 1977; 20 were new clients, 3 were carried over from the previous year. Recovery estimated that 75% of their members were between the ages of 25-35, 20% between 36-59, and 5% over age 60. No estimates were made on sex or income levels. About 90% of their members are from Iowa City; 5% are from Coralville and 5% from the small cities in Johnson County. 0 The Iowa City Crisis Intervention Center provides over the phone and walk-in counseling for individuals who may be mentally or •emotionally troubled. While they do not "treat" mentally ill people, they are to be considered as a'resource in the mental health 'delivery system. 4580 contacts were made with the Crisis Center involving a crisis situation or requiring information about and referral to services. Fifty-five percent of the clients were men; 45 percent women. Eighty-seven percent,were over age 18; 13 percent under 18. Eighty-one percent were non -students; 19 percent were students. One. -hundred eleven calls were made to the Crisis Center concern- ing suicide in 1976. Seventy-two percent were made by the individ- ual, while 28 percent were from others concerned. For suicide calls, 34 percent involved males, 66 percent females. Ninety-five percent were over the age of 18 and 70 percent were non- students. Summar --since several agencies coula not give accurate client counts, it is impossible to judge how many Johnson County clients were treated for mental illness in the last year. Of those who did report, however, approximately 1634 clients were served by all agencies excluding the Crisis Center figure of 4380 contacts. An individual who is being served by more than one agency may be counted more than once; this is not an unduplicated count. When all client information furnished to us is summarized, the following conclusions can be made: 1. Males make up about 41.6% of the clients served; women, 58.8%. More women are being seen than men. • C� 12. 2. The 25-35 age group constitutes the highest percentage of clients served. The average percent by age group are as follows: '0- 4 - less than 1% 5-12, - 7.45% 13=18• - 10.5 % 19-24 - 16.6 % 25-35 - 40.25% 36-59 - 21.1 % 60 $ over - 8.9 % 3.• Most clients fall within the $10,000-$25,000 income br.aclet: less than $5,000 - 17% $5,000-$9,999 - 34% $10,000-$24,999 - 44% $25,000 F, Over - 5% 0 • 13. SERVICES PROVIDED Services provided through the Mental Health Delivery System are: inpatient psychiatric care, outpatient psychiatric care, psychiatric partial hospitalization/intermediate care, emergency psychiatric care, residential treatment of the emotionally disturbed, transi- tional care of persons recovering from mental illness, maintenance, prevention, support groups and crisis intervention. are is a program designed to prcvide Inpatient Psycfiiatric C treatment to mentally ill individuals who require temporary care because of severe mental illness. The basic objective of the program is to return the mentally ill person to society as a useful and pro- ductive member of society and to assist him or her and his or her family to accept limitations imposed by the illness. Program elements include: services provided under medical supervision by psychiatrists, psychiatric social workers, psychologists, psychiatric nurses, et al; and cooperation with community agencies and referral following dis- charge, where indicated. Follow-up treatment after discharge aimed at post-hospital social adjustment (aftercare) of patients may be included. Admission to inpatient facilities may be on a voluntary or involuntary basis. The admission procedures are found in Appendix I. Psychiatric Hospital is part of the University of Iowa Hospitals and Clinics and provides inpatient psychiatric care .to Johnson County residents. Psychiatric Hospital programs offer treatment for all types of psychiatric problems and for problems in daily living, such as grief or divorce. Treatment is generally short term or evaluative in nature. The following methods are used in the treatment of patients: diagnostic evaluation; individual and group psychotherapy; behavior therapy; chemotherapy, and electroshock therapy. There are.no eligi- bility guidelines for admission to psychiatric hospital. Fees are charged for treatment on a slidin scale. Services 14. can also be providelohrough State Hospital Pas allocated to counties. Unlike the state papers for medical treatment, which is handled through County General Relief, determination of the financial need of individuals for state papers for Psychiatric Hospital, whether as voluntary or involuntary admissions, are handled through the County Attorney's office. The Assistant County Attorney asks the patient, or the family of the patient, if the patient is unable to complete the questionnaire, to give information on legal residency, income from all sources, household expenses and incumbrances, and the number of people living in the household. On the basis of the is made information, a determination/of whether the individual will be granted free treatment under state papers, or will be obligated to pay for the service on a sliding scale. While no appeal procedure is specified in the statute instituting this process, the individual may ask for reconsideration of the fee by the Couniy Attorney's office. The•Xlient's initial evaluation will be covered by -the state papers program only if there exists a possiblity of hospitalization. Outpatients services are not covered, although aftercare may be. Seventy-four percent of the funding for Psychiatric Hospital cones through direct appropriation from the State of Iowa, the remainder from patient and other payments. Because of the availability of state papers, it is less costly for the county to send a patient to Psychiatric Hospital than to Mount Pleasant, which the counties share of the cost is.80%. Referrals for service are made to or received from state hospitals, local mental health centers and private practitioners. Psychiatric Hos- pital has not joint planning or advisory relationships with other agencies. Johnson County clients are refered more frequently to Psychiatric Hospital than Mount Pleasant.,for inpatient treatment because of the desireability to keep people in their home communities: I • 0 is. Mount Pleasant Mental Health Institute provides patient treatment of Johnson County residents using the methods of services delivery which include a comprehensive treatment program of group work, individual psy- chotherapy, discriminating use of medication, activity therapy, dental ser- vices a full gamut of medical services and aftercare planning. Treat- ment may be for more prolonged periods of time than is usually given by Psychiatric Hospital. There is no eligibility for service. 4_per_diem rate is charged to the patient; if he is unable tp pay; the counties will purchase the service for their legal residents. No information regarding income was available. Juvenile courts, district courts, and the Department of Social Services refer clients to the Mount Pleasant Mental Health Institute. In addition, individuals may voluntarily admit themselves. MHI refers to halfway houses, group homes, private residential treatment centers, sheltered care, nursing homes, and county care facilities for post - hospitalization services. Inpatient care for Johnson County residents is also provided by the Veterans Administration Hospital and _Mercy Hospital although no specific information regarding these services are available. Vet- erans Administration has a separate psychiatric unit; Mercy Hospital does not. ,Aftercare is follow-up treatment after discharge aimed at post- hospital adjustment of patients vision of medication. Aftercare may include medical super- r 0 16, The Community Mental Health Center is most frequently referred to for aftercare, or post -hospitalization treatment, by inpatient treat- ment facilities. A treatment plan is developed fot the individual and carried out on an outpatient basis by the Mental Health Center. Mount Pleasant has a formal agreement with the Mental Health Center to provide aftercare services. Psychiatric Hospital provides out- patient counseling with its own staff resources, but also utilizes the Mental Health Center for aftercare. Patient Advocate: Mrs. Catherine Wombacker serves as the patient advocate for Johnson County residents who have been committed to mental institutions by the courts. Most of the patients that the advocate acts on behalf of are receiving treatment at the VA Hospital, Psychiatric Hospital, Mount Pleasant, or the County Care Facility, although some may be referred out of state. Senate File 499, entitled an Act Related to the Hospitalization of the Mentally Ill, created the Patient Advocate positions. She begins her work when called upon by the patient, family or physician. The most typical reason for being called upon is that the patient states he does not know why he has been hospitalized. She also works with the patient at time of discharge in the areas of employment, housing, and other problems. As an advocate, she receives a report on the patient 15 days after admission, then 30 days, and every 60 days following for as long as the patient is in the institution. The position of advocates require no specific training Workshops, however, are offered. 0 0 17. Outpatient Psychiatric Care is a program to diagnose and treat individuals whose mental health has been severely affected, who need professional help and are able to stay in their own homes or a substitute facility, and thus do not require 24-hour care. The program provides both intensive and supportive treatment under a variety of auspices and professional disciplines. Program elements include coordination teams consisting of psychiatrists, psychiatric social work- ers, and psychologists. The Mid -Eastern Iowa Community Mental Health Center, Psychiatric Hospital, Research and Training Clinic, the University of Iowa Department of Psychology, and private psychiatrists and psychologists provide out- patient services to Johnson County residents. The Mid -Eastern Iowa Communitv Mental Health Center, in addition to outpatient treatment (including emergency), provides consultation, education and community planning services, training services, and research - and demonstration services. The methods of service delivery are: indi- vidual, group, couples, and family psychotherapy and chemotherapyi consulta- tion, education and planning; training in helping skills and assertiveness; demonstration, lectures and publications regarding innovations in service delivery. The only eligibility requirement for services is that clients reside in one of the three counties served by the agency. Fees charged for services are related to the client's ability to pay, and some clients are covered by Title XIX Medicaid. Funding for the agency is derived from several sources: Johnson County (59%), Cedar and Iowa Counties (27%) and fees (10.7%). Referrals to the Mental Health Center were received by both IAppendix k2 Contains definitions for Individual Psychotherapy, Couples Psychotherapy, Family Psychoterapy, Group Psychotherapy and Chemotherapy as well as diagnostic Services. • individuals and agencies: 9 18. Self 45% Community Agencies 4% Other Patients 9% County Social Services 4% Friends 8% Schools 2% Physicians 6% Clergy 2% U of I 6% Parole/Probation 1% Courts $ Attorneys 6% Crisis Center 1% Mental Hospital 4% Other 21 Referrals from the Mental Health Center are made to Lutheran Social Service, University Counseling Service, Psychiatric Hospital and Student Health Services when service cannot be provided within a short time due to waiting lists. The Mental Health Center has joint planning/advisory relationships with the Crisis Center and the Rape Victim Advocacy program. Outpatient services are also provided by the Psychiatric Hospital, although outpatient services were not distinguished from inpatient ser- vices in the description of agency programs. Psychiatric Hospital provides extensive diagnostic services not available through all outpatient pro- grams located elsewhere. The Mount Pleasant Health Institute also provides outpatient services, although to a lesser degree due to a limitation on the num- ber of staff available to deliver services and the distance from the patient. The purpose of the program is to modify or elim?nate a patient's mental illness to such an extent that the patient can be maintained in a community setting without being referred to a hospital. Referrals to the program include those from local community school districts, parents, probation offices, and juvenile courts. Referrals are made to school psychologists, school guidance counselors, and local community mental health centers. The Research and Training Clinic, Department of Psvchology, Univer- 0 0 19. sity of Iowa, provides diagnostic and short-term psychotherapeutic services to adults, children, and families with a wide variety of problems amenable to outpatient care. The Research and Training Clinic's pri- mary purpose is the training of graduate students in clinical psychology,_ and therefore client eligibility is limited to those who prove to be . good teaching cases. No fees are charged for the service. Funding for the Clinic is provided through.the University of Iowa and National Institute of Mental Health grants. The Clinic refers to the Mental Health Center, University Counsel- ing Service, and Families, Inc. when they are more appropriate for particu- lar services needed. Referrals are routinely received from the Johnson County Department of Social Services, University Counseling Service, school psychologists, the Mental Health Center, Crisis Center, Goodwill Industries, Speech and Hearing Clinic, the U of I Child Development Clinic, and local clergymen, psysicians, and lawyers. The Clinic does not have joint planning/advisory relationships with other agencies or organizations. Outpatient Psychiatric Services. HERA, Feminist Psychotherapy provides pschotherapy for women and men by qualified psychologists and trained para -professionals and educational programs in the community about mental health and feminism. HERA was organized in 1974 by four women therapists who recognized that women and men needed' an alternative to traditional mental health care. They believed that it is not possible for thera- pists to be neutral: they either encourage people to "adjust" to bad situations or they assist people in regaining their own power. Feminist 0 0 2U. consciousness -raising may be involved in the beginning stages of thera- py. A variety of approaches, including transactional analysis, Gestalt, breathing techniques, meditation, body movement, are used. Fees are charged on a sliding scale. The only other funding for the agency comes from the University of Iowa student senate. The agency refers to Legal Aid, Emma Goldman Clinic, University of Iowa Hospitals, Dance Center, Women's Center, and University of Iowa for complementary services. HERA receives referrals from Emma Goldman Clinic, Crisis Center, and Women's Center. HERR has no joint planning/advisory relationships with other agencies. Private psychologists and psychiatrists use a variety of techni- ques in treating individuals. The three who completed the questionnaire sited the following methods: transactional analysis, group and individual therapy, Gestalt techniques, therapy using a feminist perspective, reality - based -action oriented, chemotherapy and psychotherapy. The problems which individuals most frequently bring to them are: depression, lack of self-confidence or assertiveness, feelings of going crazy, anxiety, and problems related to marriage, family, and divorce. One psychologist is also asked to work with juvenile offenders and con- duct psychological evaluations. 0 0 21. The three were willing to take third party payments; contracts are held with Vocational Rehabilitation, Juvenile Probation, and the University of Iowa, in addition to receiving payments through Title XIX Medicaid. The did not, however, use a sliding scale for patient fees. A few clients (2-10%) were referred to publically and/or voluntarily subsidized agencies in the last year. The agencies to whom they referred for subsidized services were: Psych Hospital, Community Mental Health Center, U of I Counseling Services, Crisis Center, specific practitioners or the Linn County Mental Health Center. If clients need referral for reasons other than financial ones, the following resources are used: Owen Duffy, Psychologist; Women's Resource and Action Center; Parents Without Partners; Crisis Center; University Counseling Service; and HERA: Feminist Psychotherapy. The private practitioners completing the questionnaire received referrals from: Juvenile Probation, Johnson County Social Services, Johnson County Attorney's Office, Johnson County Sheriff, Vocational Rehabilitation, and the Cedar Rapids YWCA. 0 0 22. Partial Nosuitalization/Intermediate Care commonly known as "Day Treatment" is a program designed to diagnose and treat individuals whose mental health has been severly affected, who need professional help, and, who are able to stay in their own homes or in substitute facilities and thus do not require 24 hour care. The program elements are essentially the same as in the outpatient psychiatric care program except: 1) the duration of the treatment is usually much longer and more intensive; and 2) teachers, occupa- tional therapists, and recreational workers are included in the team providing the treatment. No day treatment is available for adults in Johnson County. The Psychiatric Hospital is scheduled to begin an adolescent day treatment program in October, 1977. It will serve six children. and include individual psychotherapy, group psychotherapy, family psychotherapy as well as special education. It is designed to serve those children who cannot function in a regular, a even special school setting. Funding for the program will come through the University hospital and fees will be charged on a sliding scale. The Resource Action Program (RAP) which was formerly run by Psych Hospital, will be absorbed by the Iowa City school district. The focus will be on special education, with children moving from the RAP program into the classroom.. as soon as possible. Families, Inc., while not providing day treatment in the cl'asical sense, works intensively with families in their own homes for up to several hours per day. The program of this agency, while providing an alternative to clients of the mental health delivery system, will be considered in more depth in the Family and Individual Cou,.seling profile. 23. Emergency Psychiatric Care is a program designed to provide emer- gency intervention in a psychiatric crisis to prevent the crisis from becoming a chronic disability or suicide. The essential element of an emergency psychiatric care program is that it is readily availabe and accessible 24 hours a day to potential clients. Psychiatric hospital provides emergency 24—hour treatement, as does Mercy Hospital in Iowa City, Veterans Administration Hospital and Mount Pleasant MHI. The emergency commitment procedure can be found in Appendix 1. The Iowa Citv Crisis Center has a suicide line which is avail- able during the hours when the Crisis Center is not open (2:00 a.m. to 11:00 a.m.) The Crisis Center uses trained volunteers to man the phones with back-up provided by the Mental Health Center. The Mental Health Center staff provide outpatient emergency service on weekdays during working hours, and also receive emergency calls at home. Residential Treatment of the F,motionally Disturbed is a program designed to provide intensive psychosocial treatment to individuals suffering from some severe emotional disturbance, who are temporarily unable to live in their own homes and who need controlled group living. The residential treatment program is oriented toward a speedy return of the client to his or her normal environment. Program elements include: study and diagnosis to determine and develop a treatment plan for each client; work in behalf of or directly with the client in a therapeutic milieu during placement (including provision of group living facilities and the essentials of daily living, such as meals, clothing, arrangements for education, recreation, religion, medical— dental care, and other supervision); provision of treatment services as needed by each client (social work, psychiatric, psychology, remedial • • 24. education); work with parents of children in placement, and post- placement activities during a readjustment period. The program is usually designed for emotionally disturbed children. Note: The essential difference between an inpatient (hospital) psychiatric care program and a residential treatment program is that, in the former, all care is prescribed and directed by a physician and, in the latter, treatment plans are made and carried out by a team, with the physician serving primarily as a consultant. Orchard Place in Des Moines was the only agency providing residential treatment for the emotionally disturbed responding to our questionnaire. The number of Johnson County clients served by the agency was not given. Cottage life, special education, and indivi- dual psychotherapy are coordinated and directed toward enabling the emotionally disturbed child to acheive a life adjustment sufficient - to return him to his usual and/or future home. Eligibility require- ment include age between 6 and 16, average or potentially average intelligence and parent (s) or parental substitute involvement. Services are purchased by the State Department of Social Services. Referrals to the program are routinely received from DSS, Juvenile Court, and public schools for reasons of failure of outpatient therapy to alleviate problems at school or home, readiness to leave a hos- pital setting, or failure to adjust to foster care. A client may be referred back to DSS for intellectual remediation or maximum physi- cal security and/or supervision, if needed. Four other agencies in the state offer a similar program: Beloit in Ames, Quad Cities Childrens' Center in Davenport, Bremwood in Waverly, and Hillcrest in Dubuque. 0 0 25. Transitional Residential Care of Persons Recovering from Mental Illness is a program designed to facilitate a smooth transition of the mentally ill from a protected and structured setting when the person is returned to the community. Halfway houses are organized to help recovering patients get gradually adjusted to reintegration into the community and the resultant exposure to the stress of unsupervised living. Pro- gram elements include: provision of congregate living quarters on a residential care basis; and offering of flexible arrangements (in and out) for activities to expedite the individual patients adjustment to work, home and the normal community enviornment. Psychiatric treat- ment may be provided as needed on a reduced basis to selected patients. No halfway house is available for men recovering from mental illness. Hillcrest Family Services - Iowa City Residence for Women provides a group home for adult women, 18 years of age and older who have a history of mental illness/hospitalization and are unable to function independently. The goal is to equip them emotionally, voca- tionally and socially to live independently and to be contributing citizens. Group and individual counseling and the development of social living skills are available within the facility. Community resources for vocational and recreational services are used whenever possible. Women 18 years of age and over who are eligible for Title Xy (DSS funds) or Mental Health Institutional Funds and who have approval from a medical doctor for the use of the Hillcrest facility for their situation are eligible. Clients who need medical care are regularly referred to University Hospitals and/or the Community Mental Health Center. Referrals for vocational/job training are regularily made to Goodwill • 0 26. Industries and Vocational Rehabilitation. Referrals to the program are routinely received from Vocational Rehabilitation, Department of Social Services, Goodwill and Psychiatric Hospital. The Department of Social Services has influence over the nature of the program through funding of vocational training for the women. Funding for the program is provided from Title XX funds for services and Johnson County for maintenance. No halfway house is available for men recovering from mental illness in Johnson County. 11 • 27. Maintenance services are provided to individuals with chronic physical and/or mental ill health conditions in order to prevent deterior- ation in those conditions through residential or group care. Mainten- ance services are generally utilized for those individuals who have returned from inpatient treatment and for whom further treatment is not deemed to be beneficial. The Johnson County Care Facility is the primary resource of maintenance care for Johnson County residents. It is a 'licensed home for custodial care. Clients are charged fees, however, they very rarely pay the full cost of the service. The County Care Facility is funded solely through Johnson County. Clients are referred by doctorEsorders, although the places where clients are referred is not specified. Community services, again not specified, are available to and utilized by the residents of the County Care Facility. The program has a joint planning/ advisory relationship with the Johnson County Board of Supervisors. The Iowa Veterans' Home in Marshalltown provides longterm care in the dormitory, nursing care, or extended care for the geriatric or chronically ill veteran; spouse or widowed spouse. The Veterans' Home may furnish domiciliary care to: a). a veteran who was discharged or released from active military, naval or air service for a disability incurred in or aggrevated in line of duty, or a person who is in re- ceipt of disability compensation, when he is suffering from a permanent disability, tuberculosis or neuropsychiatric ailment, and is incapaci- tated from earning a living and has no adequate means of support; b). a veteran of any war of service after January 31, 1955 who is in need of domiciliary care if he is unable to defray the expenses of the necessary domiciliary care. 0 • 28. Fifteen Johnson County residents were being served as of May 1, 1977. It is not known how many individuals are illness related problems. There are an average of 46 individuals on the waiting list for service for the dormitory care, a one year wait for the nursing home care. Support Groups offer informal peer counseling to individuals who have similar personal experiences. Recovery, Inc. is a systematic method of self-help after-care to prevent relapse in former mental patients and chronicity in nervous patients. It is an organization of lay people professionals, such as physicians, psychologists and clergy are welcomed to come and observe meetings, but not to participate in the weekly meetings unless patients. Members must be over the age of 18. In the period of time between April 1976 and April 1977 ap- proximately 20 new people were served Recovery, Inc., three were carried over from the previous year. The organization has no source of funding. The only referrals which are made by Recovery, Inc. are the suggestion that the individual contact his doctor or social worker who made the origional referral to Recovery, Inc. Recovery, Inc. received referrals from Psych Hospital. Prevention services are aimed at enabling individuals to develop methods of coping with everyday stress, thereby reducing the likelihood that mental illness will develop; and conducting research into the causes of mental illness. Program elements include training day people in the develop- ment of coping skills; increasing the level of competency of indivi- duals in the helping profession in dealing with mental illness and the development, organization and dessimi.nation of knowledge on mental . health issues. n LJ • 29. The Mid -Eastern Iowa Community Mental Health Center conducts training workshops in rural areas for teachers, clergy, nurses and others who want to improve their abilities in helping people with their personal problems. Research and evaluation is an activity conducted primarily by the University of Iowa; however, the.M..ental Health Center also participates in research and evaluation in some areas where the Center's services will not be disrupted by it. The Mental Health Association of Iowa works to increase research into causes, prevention, and treatment of mental illness. It is a state- wide organization with a regional office in Coralville. The organiza- tion supports legislation aimed at increasing research into the causes and cures of mental illness. It also conducts worry clinics through out the state, although now have been offered in Johnson County. The agencies services are delivered primarily on a indirect basis, that is; on behalf of population or client groups, rather than to specific indi- viduals. Advocacy attempts to plead, argue, or urge the case for the pro- vision of adequate mental health services for all individuals in society. Program elements include: development of materials; and communication of agreements to selected parties or public at large as needed, through the use of every available technique not prohibited by law. The Mental Health Association lobbies to ensure proper pro- vision of services to the mentally ill and follows up on complaints made to it by clients seeking treatment from mental health services. The agency also provides speakers to community groups on issues affecting mental health, and provides canteen cards to residents of the county care facility. • • 30. UNMET NEEDSIPROBLEMS IN SERVICE DELIVERY The unmet needs of the Mental Health Delivery System can be grouped into the following categories: Lack of common data base and outcome measures; inability to pay for outpatient services/shortage of sliding fee scale availability; lack of comparable and valid data col- lection and lack of outcome measures; inadequate cooperation and con- sultation among service providers in the mental health delivery system. Lack of common data base and outcome measures was a problem with which the sub -committee had concern. Agencies are not currently keeping comparable statistics, therefore it is difficult to make any comparison in types of clients served, problems addressed, treatment given, and the cost of delivering service to Johnson County clients. At the present time, no information is available as to whether treat- ment has resulted in improvement of the clients' mental health or general wellbeing. Inability to pay for outpatient services/shortage of sliding fee scale availability: The Mid -Eastern Community Mental Health Center, the major provider of outpatient mental health treatment available on a sliding fee scale, has a 4-6 week waiting list. They refer clients, because of the waiting list, to Lutheran Social Services, University Counseling Services, Psychiatric Hospital,and Student Health Services. Lutheran Social Service also has a long waiting list and must cut back on the amount of counseling time available to Johnson County because of their obligation to provide additional services to the rural counties in their area which support them financially. University Counseling Services can serve only students, faculty, and staff of the University of Iowa. They are not able to serve indi- viduals who need long term counseling (beyond 8-12 sessions) at the present time even though they see a great need for such services. 0 31. Many of the clients served by Psychiatric Hospital are those who need evaluation or medication monitoring, although on-going outpatient counseling is available. The .ounty ttorneys office is required by law to certify eligibility for state papers for Psychiatric Hospital. State papers are not available to individuals requiring outpatient services or evaluation_if hospitalization is not being considered._ HERA also stated that there is a need for funding to supplement low- income clients to make it's services available to a broader range of people. Lack of comparable and valid data collection and lack of out- come measures. currently, agencies are recording client statistics in a variety of ways which make comparison from one agency to another difficult. Collection of information on the problems facing indivi- duals _s.not done by most agencies. Because of this program planning involving a number of agencies is difficult. At the present time, few agencies are capable of documenting the outcome of their service to individuals and families. It is impos- sible, in effect, to tell if the service has "done only good" Inadequate cooperation and consultation among service providers in mental health delivery system were problems cited by several churches and agencies. It is common for more than one helping agency or individual to be involved with a client or his family. At the present time, information which would benefit the client and aid in his treatment, are not always shared with other appropriate helping professionals. Lack of familiarity with the staff of other agencies seems to be a contribut- ing factor. While confidentiality must be preserved, cooperative arrangements among the helping professionals should be made so that the client is offered the most appropriate and effective treatment. 0 0 32. Client Groups Dispzopor:iately Represented in A�:encv Caseloads: Through analysis of the data collected from the agencies, two groups stood out as disproportionately being repre- sented in client statistics: a) women comprise 64.60 of the clients being seen by mental health programs, while men made up only 35.3; of the total. This is contrasted to the percentage of men in substance abuse treatment (80%) and in the cor- rectional facilities and programs (90%). b) Individuals in the 25-35 age group made up 50.81V of the total clients seen; pointing out that these are evidently years of great stress. While no attempt at explaining these phenomena is being made, they perhaps deserve further study to ascertain if changes in agency programs are required. *Other Problems Cited by Agencies or Individuals: 1) Need for a halfway house for men (clergyman) 2) Need for preventive mental health (clergyman) 3) The county attorneys office is not staffed or adequately equipped to deal with financial eligibility determination of psychiatric state papers. (assistant county attorney) 4) Little money for follow-up and aftercare following residen- tial care (Orchard Place) 5) Few programs for low -intellect children with severe be- havior problems (Orchard Place) 6) Few settings where maximum physical protection is avail- able if needed (Orchard Place) 7) The new committment law and it's implications should be examined by the therapeutic community (Mental Health/ Chemical Dependency Committee) 8) Special assistance in job and housing location is needed for people returning from mental illness treatment. (Patient Advocate) *Agencies and Individuals Citing Problems are contained in paren- thesis. Appendix I • • 33. EMERGENCY ADMISSIONS oc.e Officer taxes nesponu into custody and to the rr:arest available facilit Ilntiif—les nearest available magistrate to proceed to facility. Legal counsel provided if practicable. Magistrate makes writte smissal order for Case Fitivnediate hos italizati hief Medical Officer I examines Respondent detained not to Disrlrnrge exceed 48 hours, excluding week -ends and holidays. Emergent treatment only, rrrrnt with Datient's cons untary I Involuntary Discharge fission Procedures 0 0 34. VOLUNTARY ADMISSIONS I Person applies ror Voluntary Admission to hospital Hospital Admits tor observation, diagnosi care and treatment Discharge 4on patient's Discharge request at any time Hospital Gare not Required Unless hospital applies for ludicial certification Case Dismissed • . INVOLUNTARY ADMISSIONS • Application filed in District Court by any interested person. Verified by Clerk of Court Preliminary Hearing - Judge Reviews Case If necessary, place Respondent in custody until formal hearing 35. rormai nearing. Respondent repre- sented by own Attornev. Case Dismissed I I Hospitalization Ordered unser meaicai Otricer Reports to Judge within 15 days. Possible extension of 7 days _Ler Court Order Continur•.I Out -Patient Other Discharge Hospitalization tare Placement (Report to Court(Report to Court (Report to [n0 days ^iter entry 60 days after entry Court every f order. Thereafter of order. Thereafter 6 months.) ot to ezceed 60 days.) not to exceed 90 days.) Discharge I 9 Appendix .N2 Outpatient Servicesl Individual Psychotherapy 36. Treatment by individual interview, such as supportive psychotherapy, relationship therapy, insight therapy, behavioral therapy and play therapy. Couples Psychotherapy Therapy applied with a couple as a unit, such as spouses experiencing marital dysfunction. Family Psychotherapy Therapy applied with a family as a unit. Significant members of the family are seen together and considered as patients. (Excludes groups of families or married couples.) Group Psychotherapy Treatment by the use of grouD dynamics or group interaction, such as.therapy with groups of married couples or with groups of adolesents. (Excludes Family Psychotherapy.) Chemotherapy Treatment by use of medications. Diagnostic Services Psychiatric, social work, psychological or ether mental health professional evaluation, a psychodiagnostic process including such thi.gs as a psychiatric history and mental status examination, study of personal background and family interactions, and evaluation of cognitive processes and personality characteristics. lIowa Communit Dfental Health Centers AccountingManual, "Definition of e vice ements n. 'sychiatric Care No. of Johnson Co. Clients Served AnSDiCeS Funding 172 public F state University of Iowa 46 public & state state & counties NA puplic B state Veteran Adminis- tration NA private not insurance for profit patient fees SERVICES AVAILABLE talization and intermediate Care No. of Johnson Co. H1' 'b'lit Fees Clients Served Auspices Funding Agency Psychiatric Hospital adolescent sliding scale state papers Program - Emer potential of 6 (will begin operation 10/77) ncy Psychiatric Care public state University of Iowa • Psychiatric none sliding NA public public $ state Hospital scale state papers insurance Veterans Ad- Veteran none NA public Veteran Adminis- ministration federal tration Hospital Mercy Hospital none insurance NA private not patient fees.. sliding for profit insurance scale Mount Pleasant none patient fees J1A public State 4 Count* county state Pay Iowa City Crisis Center none none ]1] private not County- 69.6% for profit United way- 30.3% U co SERVICES AVAILABLE. Program - Outpatient Psychiatric Care No. of Johnson Co. Agency Eligibility Fees Clients Served Auspices Funding Mid -Eastern none sliding 724 private not Johnson County -59$ Community Mental scale, title for profit Other Counties -27% Health Center Medicaid Fees- 10.7% Medicaid- 1.7% • _ Mount Pleasant none patient fees 1 •public- State $ County county pay state Private none varies NA private patients fees psychiatrist profit making psychologist HERA, none sliding 433 private not patient fees Feminist scale for profit University of Iowa Psychotherapy Student Senate Research $ Training must be none 83 public $ University of Iowa Clinic, U_ of Iowa good sub- state Dept. of Psychiatry ject for teaching ding tate $ Dept.. of Services ty d Way County- 59% ounties- 27% -1.0.7% d - 1.7% v HUMAN SERVICES STUDY SUBSTANCE ABUSE PROFILE October 7, 1977 Mental Health/Chemical Dependency Sub -Committee Members: Verne Kelley - Chairman Gladys Benz Graham Dameron* .David Henson Paul Huston Staff: Connie Echternach and Jill Ferguson Johnson County Regional Planning Commission 221x7:South Dubuque Street Iowa City, IA 52240 �i'056 ' TABLE OF CONTENTS Substance Abuse GOAL. . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE DEFINITION . . . . . . . . . . . . . . . . . . . . 1 Service Elements . . . . . . . . . . . . . . . . . . . . 1 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . 1 Problem description --alcoholism . . . . . . . . . . . . . 3 Problem description --chemical abuse. . . . . . . . . . . 8 POPULATION SERVED Alcoholism . . . . . . . . . . . . . . . . . . . . . . 6 Chemical abuse . . . . . . . . . . . . . . . . . . . . . 10 SERVICES PROVIDED --SUBSTANCE ABUSE . . . . . . . . . . . . 12 Emergency treatment . . . . . . . . . . . . . . . . . . . 12 Inpatient treatment . . . . . . . . . . . . . . . . . . . 13 Intermediate care. ... 13 Outpatient care . . . . . . . . . . . . . . . . . . . . 14 Aftercare . . . . . . . . . . . . . . . . . . . . . . . . 14 Outreach. . . . . . . . . . . . . . . . 14 Consultation and education . . . . . . . . . . . . . . . 15 Maintenance services . . . . . . . . . . . . . . . . . . 17 Support groups . . . . . . . . . . . . . . . . . . . . . 17 Support services .. . Funding for substance abuse*treatment. . . . . . . . . . 20 UNMET NEEDS. . . . . . . . . . . . . . . . . . . . . . . 23 Programs and facilities . . . . . . . . . . . . . . . . . 23 Prevention/education . . . . . . . . . . . . . . . . . 23 Services to the indigent . . . . . . . . . . . . . 24 Early.identification of substance abusers. . . . . . . 25 Office of Planning and Programming . . . . . . . . . . 25 Payment for substance abuse treatment. . . . . . . . . 26 Programming for youth . . . . . . . . . . . . . . . . . 26 Delivery system concerns . . . . . . . . . . . . . . . 27 Data. . . . . . . . . . . . . . . . . . . . . . . . . 28 APPENDIX 1 Agencies which Provide Substance Abuse Treatment Services . . . . . . . . . . . . . . 29 APPENDIX 2 To Whom Agencies Refer . . . . . . . . . . . . 35 APPENDIX 3 From Whom Agencies Receive Referrals 36 APPENDIX 4 Influential or Planning/Advisory Relationships Affecting Service Providers. . . . . . . . . . 37 SUBSTANCE ABUSE PROFILE GOAL: Reduction in the number of Johnson County residents whose intentional use of a substance is harmful to their health and general wellbeing. Service Definition: The substance abuse prevention and treatment program area is aimed at the alleviation of the dependence upon chemi- cals for daily living through identification, motivation, counseling, and general rehabilitation of the chemically dependent person and through education toward prevention and abuse. Program elements traditionally include: Alcohol - detoxification treatment: psychiatric treatment, and group, individual and family therapy. Drugs - psychotherapy, group therapy, reality -encounter therapy, and methodone maintenance. Treatment may be provided on an inpatient or outpatient basis depending on the needs of the patients. Problem Description: The Iowa Health Systems Agency defines the prob- lem of substance abuse in their 1977 State Plan. "Substance abuse is a costly health and social problem. It affects both abusers and non - abusers. An abuser uses a substance in such a way that it adversely affects some aspect of his/her life such as physical health, mental health, relations with family and friends, and/or occupational or edu- cational functioning. Non -abusers, especially family members of abusers, are also victims of substance abuse; as individuals they can become just as disfunctional as the substance abuser. With help, family members can be returned to a healthy status, even if the sub- stance abuser never deals with his/her problem. Substance abuse, in M • 2. addition, has overall effects on all citizens who must bear the cost of prevention and treatment programs, and the related costs of lost productivity, accidents, crime and other social problems." (HSA Plan, Aug. 1977. p. IV -31). The plan continues to describe the character- istics noted more frequently among substance abusers. "These charac- teristics include low self esteem, limited ability to cope with stress, difficulty in close relationships, physical and emotional discomfort,and lack of recreational alternatives. Something must be done about these characteristics of the problem if substance abuse is to be lessened." (p. IV -32). Drug and alcohol abuse are now considered together more frequently. Abusers of alcohol and drugs often exhibit the same characteristics and the causes for abuse are often viewed as similar. Treatment professionals in both drug and alcohol programs are seeing an increase of individuals with dual dependencies as well. The new State Department on Substance Abuse is designed to combine alcohol and drug abuse programs, at least on the state level. Most of the research done on alcoholism and drug abuse has been separate, however, and local agencies have been set up to deal with them separately also. Description of the problems and service popula- tion, therefore, will be dealt with in two parts, the first on alcoholism and the second drug abuse. • • 3. Problem Description - Alcoholism A 1972 National Institute on Alcohol Abuse and Alcoholism reported that 70 percent of adults in America use alcoholic beverages. of those who drink, about 10 percent or 6.2 percent of the total adult population, become problem drinkers or alcoholics. Estimates made by local alcohol treatment practitioners regarding the number of alcoholics run between 5 and 10 percent of the general population. Using the con- servative 5 percent figure, it could be projected that at least 3,750 alcoholics live in Johnson County. Using the Jellneck formula,which is based upon the number of deaths involving cirrohsis of the liver, the humber of alcoholics in Johnson County would be 2,117. Personnel of both the University Hospital and Veterans Hospital estimated that 40-50 percent of their general medical patients had problems associated with alcohol. These individuals are not generally channeled into alcoholism counseling at either facility. The existence of the problem in these patients is not generally known; consequently, more thorough investigation may be necessary. The NIAAA report cited the costs, both economic and social, associated with alcoholism. The life expectancy of the alcoholic is ..s.horte,ned by 10 to 12 years. NIAAA estimated 36 million people, fam- ilies of alcoholics, to be "caught in alcohol's web: unhappy marriages, broken homes, desertion, divorce, impoverished families and deprived or displaced children are all part of the toll•." (National Institute of Mental Health. National Institute on Alcohol Abuse and Alcoholism. 1972, p. 10.) They estimated the cost to public and private agencies in support of the alcoholic and family to be $2 billion per year. They further stated that "a loss of $10 billion yearly has been attributed to work time lost through alcohol problems of employees in business, industry, civilian in government, and the military. An addi- tional $3-3.5 billion can be attributed to property damage, medical 0 0 4. expenses, overhead costs of insurance, and wage losses." (p. 12) Chronic drinkers were responsible for two-thirds of the highway fatalities, and half of all homicides and one fourth of all suicides are alcohol related. A needs assessment done by MECCA states that 67.2 percent of total committments to Anamosa, Fort Madison and Rockwell City have alcohol problems. Unfortunately, NIAAA reports (and a local treatment professional concurs) that only one-tenth of the alcoholics are receiving treatment of any kind. Johnson County attorneys were surveyed to ascertain their clients' involvement with various social problems. They estimated that 25 percent of dissolution cases involved alcohol problems. They were also asked about the percentage of battered spouse cases involving alcohol. The responses averaged 55 percent. The Crisis Center reported 140 calls in 1976 concerning alcohol; 112 of a crisis nature and 28 non -crisis. The community did not feel that planning for services to the alcoholic and drug dependent were as important as some other groups. Only 20 percent of the Iowa City Peoples Survey of 1977 respondents ranked these services as most important or second most important when compared to the mentally or emotionally ill; chronically ill, physi- sically or mentally handicapped; transients; or low income individuals with families. Residents of towns in Johnson County outside of Iowa City ranked the alcoholic -drug dependent services higher, with 36 percent ranking it as first or second in importance. 0 0 School personnel were also surveyed to gain information on problems facing young people. Thirty-five percent felt that prob- lems with alcohol were increasing in the schools. _ A study of alcohol and drug use of Iowa high school students showed that alcohol is the substance of most use: PERCENT OF STUDENTS WHO USE ALCOHOL, M4RIJUANA AND OTHER DRUGS (DOWNERS, UPPERS, HALLUCINOGENS LIKE LSD) Never 961. 891. 785 urage 855 Less than once a month Freouency of Use (per Month) 6 6 10 12 Total ALCOHOL: (beer, wine, whiskey) 2 3 2 2 2-3 times a month Never 631. 44% 265 16, 39: Less than once a month 24 29 29 20 25 Once a month 4 8 10 9 8 2-3 times a month 3 12 20 22 14 Once a week 2 4 8 IS 7 2-3 times a week 1 2 6 14 5 4 or more times a week 1 1 1 4 2 . MARIJUANA: ' Never 961. 891. 785 675 855 Less than once a month L, 5 7 10 4 Once a month 0 2 3 2 2 2-3 times a month 0 2 3 5 2 Once a week 0 1 3 2 1 2-3 times a week ' 0 1 4 6 3 4 or more times a week 0 1 3 7 3 ' -DRUGS: (uppers. dormers. • hallucinogens) Never 945 96% 905 831. 925 Less than once a manth 1 3 5 8 4 Once a month- 0 1 2 2 1 2-3 tines a month 0 0 2 4 1 Once a week 0 0 I 1 1 2-3 times a week 0 0 1 1 1 4 or more times a week 0 0 0 1 0 SOURCE: Mary Hays. 'Report of the Iowa Study of Alcohol and Drug Attitudes and Behavior Among Youth,' Iowa Department of Public Instruction, 1975. • The percentages don't always add up to 100:, but an as reported by the study. . The report also indicated that the earliest age of onset for 3 drugs and alcohol to be decreasing. "In 1974, the earliest age of on- set was nine while among those interviewed in 1976, several began ex- perimenting with alcohol around the age of six and daily usage was reported as early as age ten.'The earliest onset age for drug usage other than alcohol was 9 with regular use being reported by age 10.111 1Incidence and Prevalence Studies of Substance Use and Abuse in Iowa 1974-1976 Highlights; Iowa Drug Abuse Authority, p. 11. 0 0 Population Served - Alcoholism Alcoholism treatment programs reported the following numbers of Johnson County clients for the most recent fiscal year: Mt. Pleasant - 14 Oakdale - 93 MECCA - 318 Veterans Administra- tion Hospital -- Knoxville - 1 *Citizens Committee on Alcoholism - 83 Lakeside - 15 Client data on age, sex, race, income, and residence was based on estimates in most cases and often incomplete. General conclusions can be derived from the data, however. Most clients (about 50 per- cent) fall between the ages of 36 and 59. This is followed by the 25 to 33 age group with about 22 percent, 19 to 24 with about 15 percent, and 60 and over with 10 percent. Men comprised about 80 percent of the client population. It 6.. should be noted, however, that most agencies were seeing an increasing number of women seeking help for alcohol problems. Agencies who gave estimates on income saw few clients with in- comes over $10,000. Of those reported, 50 percent had incomes below $5,000, 40 percent - $5,000 to $9,999, and 10 percent - $10,000 to $24,999. MECCA, in addition to income levels, had information on em- ployment status of clients. Fifty percent were employed full time, 4.7 percent - part time, 3.6 percent were housewives, 23.4 percent were unemployed and 16.7 percent were retired. Information on place of residence in Johnson County was not available in most cases. MECCA did, however estimate that 72 percent of their clients come from Iowa City and 10 percent from Coralvilie. *It should be noted that some clients will appear in the counts of more than one agency from whom they have received treatment. Consequently, this is not an unduplicated count. 0 • 7. Eighteen percent came from small cities and rural areas as follows: North Liberty - 5% Oxford - 4t Riverside - M Tiffin - 2t Hills - 1% Rural Areas - 3% Lakeside was also able to specify residents for the fifteen Johnson County clients served: Iowa City - 60 0$ Coralville - 20.0% Solon - 13.3% Tiffin - 6.6% With the absence of good data indicating numbers of clients and data on age, sex, race, income and residence it is very difficult to ascertain portions of the population which may be underserved. • • 8. Problem Description - Chemical Abuse The Incidence and Prevelance Studies of Substance Use and Abuse in Iowa - 1974-1976, conducted by the Iowa Drug Abuse Authority, found that 13 percent of all urban males and 9 percent of females responding to the survey used marijuana/hashish; for the 14 to 17 year age group, the use was as high as 35 percent. The total using LSD or other hallu- cinogens and heroin was 1 percent, and 3 percent for cocaine. The study also sampled the rural, i.e., farm residents, and found that marijuana use was lower, but LSD, heroin and cocaine usage was greater than for their urban counterparts. While prescription drug usage (cited below) .was significant for both the urban and rural populations (between 12 - 31 percent for a variety of prescription drugs) the prevalence of the high frequency user was much lower - 1 percent or less for all prescription drugs. Prescription Drug Use •General Consumption Patterns Most Frequent Age % of Drug User Sex Group Sample Sedatives Rural Male 14-17 15% Tranquilizers Urban Female 25-34 23% Urban Female 35-49 22% Diet Pills Urban Female 18-24 17% Pep Pills Rural Male 14-17 15% Urban Male 14-17 12% Analgesics Urban Female 18-24 31% lIncidence and Prevalence Studies of Substance Use and Abuse in Iowa 1974 - 1976, Highlights; Iowa Drug Abuse Authority, p. 4. 0 0 9. The Iowa City Crisis Center reported 226 calls related to drug usage in 1976; 126 were of a crisis nature and 100 of a non -crisis nature. The State Department of Health reported about 44 drug overdoses in Johnson County which involved substances such as depressants, over the counter analgesics, LSD, heroin and stimulants in the period between April, 1976 and March, 1977. S 0 10. Service Population - Chemical Abuse The Iowa Code requires that physicians, hospitals and drug treatment centers report quarterly the treatment given to persons addicted to or dependent upon drugs. In 1976, 36.1 percent of the reports came from physicians, 5.3 percent from drug treatment centers, 13.8 percent from Mental Health Institutes and 44.7 percent from hos- pitals. No indication was given on the number of individuals each of these reporting sources treated. In 1976 a total of 3,646 persons were treated in the state of Iowa, twenty-one of those coming from Johnson County. Reality X re- ported to our committee having treated a total of twenty-one indivi- duals on an out-patient basis, and five as in -patients from Johnson County during the same time period. No explaination was made for the discrepancy between the number reported to the state and that which was reported to us by Reality X. Of the total number of individuals treated in the state, 59.8 percent were unemployed, 24.2 percent had previous rehabilitation services, 10.4 percent were receiving some sort of public assistance, 43.3 percent were treated as out-patients and 55.6 percent were treated as in -patients. No breakdown for Johnson County was given. Reality X did estimate, however, that 75 percent of their Johnson County clients had incomes below $5,000. 0 0 The following age breakdown of clients were given by the State Department of Health and Reality X: DRUG TREATMENT REPORTED TO THE IOWA DEPARTMENT OF HEALTH AGE NUMBER PERCENT 15-19 4 19.0 20-24 6 28.5 25-29 8 38.0 45-49 1 4.7 60-64 2 9.5 TOTAL 21 99.7 REALITY X AGE NUMBER PERCENT 13-18 6.5 25.0 19-24 13.0 50.0 25-35 5.2 20.0 36-59 1.3 5.0 TOTAL 26.0* 100.0 *Reality X estimated the percentage of their clients falling within the age groupings. 11. Only treatment of individuals whose primary diagnosis is drug abuse must be reported, therefore it is likely that medical doctors and mental health professionals who do not consider an individual's drug usage as the primary diagnosis are not required to report to the State Department of Health. This is because drugs and alcohol are used by individuals who have other problems; conversely, prob- lems may arise from the use of alcohol or drugs. Individuals with alcohol as the primary substance of abuse, but who are also using other chemicals, would also not appear in the report. Several of the alcoholism agencies reported an increase in dual -dependencies. 0 0 1 12. . Services Provided - Substance Abuse The Accreditation Manual for Alcoholism Programs published by the Joint Commission on Accreditation of Hospitals - Accreditation Council for Psychiatric Facilities defines eight levels of care and treatment of substance abusers: emergency treatment, inpatient treatment, intermediate care, outpatient care, aftercare, outreach, consultation and education. These definitions can be used to cate- gorize the services available to Johnson County residents for sub- stance abuse treatment. Emergency Treatment - Emergency treatment is defined as follows: "The emergency care system shall provide for 24 hour availability of the following services to all persons and their families with problems related to alcohol use and abuse: 1) immediate medical evaluation and care; 2) supervision of persons by properly trained staff until they are no longer incapacitated by the effects of alcohol; 3) evaluation of medical, psychological, and social needs, leading to the development of a plan for continuing care, and 4) effective transportation services." Emergency services are most commonly used for the detoxification process. Oakdale Hospital is certainly the most frequently used resource for detoxification for Johnson County residents, although other sources are used from time to time. Law enforcement officials must now offer to take an indi- vidual to a detoxification facility if picked up for intoxication. They most frequently take the person to Oakdale. Iowa City police frequently call upon MECCA to counsel with the individual and escort them to Oakdale. 0 0 13. While the Veterans Administration Hospital offers a 14 day detoxification program, they will not admit an intoxicated person unless there is a medical reason for hospitalization. Veterans Ad- ministration Hospital in Iowa City does not have a formally accredited chemidal dependency unit at the present time. Patients must be placed in the psychiatric unit. This has presented problems to police of- ficers and agencies such as Wesley House and Crisis Center when an individual they bring to the Veterans Hospital is refused admission. Individuals who are under the influence of drugs are usually taken to Psychiatric Hospital for detoxification. The Emergency Ser- vices chart in Appendix #1 describes the services available. through each agency. Inpatient Treatment - Inpatient treatment refers to treatment in a medical facility. It is defined as follows: "The inpatient component shall provide 24 hour supervised care under the direction of a physician in a hospital or other suitably equipped medical sett- ing designed for the diagnosis and/or treatment of medical and/or psychiatric illness derived from or associated with alcohol abuse and/or alcoholism." The Inpatient Treatment chart in.,Appendix #1 indicates hospitals which provide such treatment. Intermediate Care - Intermediate Care is usually associated with halfway houses. Lakeside Foundation is the exception, since it provides a 28 day formalized treatment program, similar to that of the inpatient treatment program. It is defined as follows: "The inter- mediate care component shall be designed to facilitate the rehabilita- tion of the alcoholic person by placing him/her in an organized therapeutic environment in which he/she may receive diagnostic services, counseling, vc..cational rehabilitation and/or work therapy while bene- fiting from the support which a full or partial residential setting can provides' Individuals generally enter a halfway house after an 0 0 inpatient treatment program for purposes of reintegration into the community. The chart in Appendix H1 entitled,"Intermediate Care", identifies the agencies which provide this service. Outpatient Care - Outpatient care can be used before, after or in lieu of an inpatient or intermediate program. MECCA is used most often for outpatient counseling. Oakdale and most other resi- dential programs refer the client directly to this agency upon dis- .14. charge. Reality X counsels Johnson County drug abuse clients on an outpatient basis at the MECCA facility one afternoon a week. The Mental Health Center and private psychiatrists are also used for counseling of substance abuse. All residential treatment programs agree on the necessity for on-going counseling if relapse is to be avoided. Agencies listed on the"Outpatient Treatment" chart in Appendix H1 provide outpatient counseling. Aftercare - All agencies which provide treatment provide after- care as well to some degree. The distinction between aftercare and continued outpatient care is slight in most cases. Lakeside may pro- vide the most formalized aftercare of the treatment programs, admitting patients for short stays periodically to reinforce the treatment pro- cedures. The Joint Commission on Accreditation of Hospitals defines Aftercare as "...care to patients who have progressed sufficiently through emergency, inpatient, intermediate and/or outpatient services to the point of their recovery where they will benefit from a level of continued contact which will support and increase the gains made to date in the treatment process. No chart was developed since all agencies provide aftercare. Outreach - Outreach efforts have been primarily focused upon making medical personnel in the general medical services of hospitals • 15. aware of substance abuse problems which their patients may have, and the benefits that these patients may receive from referral to sub- stance abuse counseling programs. As was mentioned in the Problem section of this profile, it is estimated that about 40-50 percent of the patients admitted to general medical service units have problems asso- ciated with alcohol or drugs. Both Veterans Administration Hospital Alcoholism Unit and Oakdale Hospital staff are attempting to do more inservice training to make medical personnel aware of the effects of alcohol abuse on the general health of patients. Other outreach efforts with which MECCA has been involved have been aimed at working with the elderly and employee groups to expand knowledge of treatment opportunities. The formal definition of out- reach: "The Outreach component shall be designed to facilitate iden- tification within a target population of persons and their families who have problems related to the use of alcohol, to facilitate pro- curement of alcoholism services, and to alert all public and private human service agencies who serve the same target population to the importance of early identification and easy access to the service delivery system. It is essential that the outreach process involve as many organizations, agencies and individuals as may be in contact with a part;of'_the target population." Consultation and Education - Many agencies are involved to some extent in preventive services, but none are funded adequately for this service. Funding for alcoholism programs is tied to direct service client counts, consequently education efforts must be considered • • 16 as "overhead". MECCA and Grant Wood Area Education Agency work with schools only upon the schools request, and to date, this service has not been actively solicited. Reality X works primarily in Linn County schools, since Linn County provides the match for their grants. United Action for Youth provides preventive substance abuse services as part of its regular on-going contact with youth. Crisis Center reached 650 people in 1976 through talks given in schools and meeting halls. The Alcohol Safety Action Program attempts to educate drivers convicted of OMV19I to the dangers of drinking and driving. They have not been successful in getting judges to refer first time 0MVWI offenders to substance abuse counseling. ASAP is available to do pre -sentence investigations on OMVUIs but is not always used. Education and Consultation are rarely separate programs in agencies. The definiticns follow: "Consultation service shall be designed to provide the individual or group seeking aid the required skills to cope more adequately with issues involving care and/or pro- gram management." "The education service shall be designed to convey on a regular and planned basis a philosophy that increases community understanding of the nature of the use and abuse of alcohol, its treatment and prevention, and the human and legal rights of the popu- lation at risk, as well as to inform the public of existing alcoholism resources and to gain public support for the development of additional resources." The chart in Appendix M1 shows the agencies involved in Preventive Services. 0 0 17. Maintenance Services - No formal definition is provided for the maintenance program. It is, however, a residential service to keep an individual at a level attained when further rehabilitation seems unlikely. The facilities housing these individuals (primarily elderly) are limited in capacity. The Veterans Home in Marshalltown has a waiting list of over a year. The Johnson County care facility is currently caring for three recovering alcoholics. Support Groups - Alcoholics Anonymous, while not a treatment program as such, is almost universally used to extend and solidify the lessons learned in treatment programs. Alcoholics Anonymous has twenty-three active groups in Johnson County providing support to recovering alcoholics. AA, because of its.anonymous nature, did not provide further information for our study. No support group exists, to our knowledge, for recovering drug abusers. • Support Services • 18.. Individuals recovering from substance abuse often time re- quire a number of supportive services to enable them to success- fully function again in society. Financial assistance is consistently mentioned by helping agencies as necessary for many individuals who have completed treatment. Those most in need are the habitual substance abusers who are homeless and lack any personal funds for necessities such as food, clothing and shelter. Oakdale and Veterans Admini- stration have small amounts of donated funds with which they can help individuals on an emergency basis, but must rely on other agencies for more on-going support. Agencies agree that the availability of such support is limited. Individuals are referred to the following agencies for financial- issistar_ce: Department of Social Services: Certification for state papers,:med9_caid, and general relief. Commission on Veterans Affairs: general financial assis- tance. Crisis Center: vouchers for food lodging and transportation. Vocational rehabilitation and job placement is required for many recovering substance abusers who lack job skills or the ability to function adequately in a competitive employment situation. The following agencies are used for training and placement assis- tance: Rehab'il'itation and Education Services Branch: gives counseling and funds for training. It should be noted that assistance • • 19. for substance abusers through this source is limited. Goodwill Industries: provides job training and competi- tive employment readiness training. Goodwill is a resource, although no agency mentioned referring to them. CETA: assists with job placement and training. Job Service of Iowa: offers employment counseling and job referral. There seems to be some question as to the ability of the agency to work effectively with this category of indi- vidual• An entirely new lifestyle must be acquired for many re- covering substance abusers, including developing new recreational outlets. The way in which an individual spends his leisure time is certainly one of the most difficult habits to change. The Iowa City Recreation Center is addressing this through special groups. Other resources mentioned by Reality X were the Cedar Rapids YMCA, YEA and Community Centers. The treatment an individual receives in a drug or alcohol program must at time be supplemented by other resources. The Community Mental Health Center, Psychiatric Hospital and Mt. Pleasant Mental Health Center provide psychiatric, psychological counseling as well as evaluation. Hospitals are also used to address the medical needs of patients. • • 20. Funding For Substance Abuse Treatment The Iowa State Department of Substance Abuse has recently been formed merging the Division on Alcoholism and the Drug Abuse Author- ity. Funding procedures for both alcohol and chemical dependency treatment programs will follow those set previously for alcoholism programs. t the individual receiving sub House File 594 specifies tha stance abuse treatment will be charged the full cost for the service. If this is not collected from "the substance abuser and any person, firm, corporation, or insurance company bound by contract to provide support, hospitalization, or medical ser- vices for the substance abuser (125.31.), the County of residence will be billed for 25% of the cost of the service and the State Dept. of Substance Abuse, 75%. In reality, however, the State ion on Alcoholism has contributed only 230 of the cost of Divis s in the past. alcoholism treatment for Johnson County resident Counties are liable only for $500 per client per year, however, this may be waived by the Board of Supervisors. The exception to the County and state liability for the treatment of a patient who is unable to pay are those who are sentenced by the court as part of OAtN sentance. Individuals who are sentenced to treatment must be treated as though they were non-residents, with the state providing 100 percent of the cost of care. Payment in-patient treatment. for detoxification is limited to five days of Counties must be notified within five days of a patient's admission. When their treatment is completed, the client is billed by the facility. If it is not paid, the bill is submitted to the Board of Supervisors of the county of residence. They are L • 21. obligated to try to collect the bill. If this is not paid, a deter- mination by the Supervisors is made as tothe financialstatus of the patient. If the patient is unable to pay, the supervisors pay the 25%. If it is determined that the individual can pay, the County Attorney is to sue for collection. It is unclear whether this limitation on detoxification will continue with the new Dept. of Substance Abuse. Services to individuals beyond detoxification e.g.,counseling and residential treatment service, while not bound by the five day rate, are limited to the 25$ reimbursement factor and $500 per client per year from counties. MECCA has a contract with Johnson County to provide services to its residents in lieu of the 25% reimbursement. The allocation is designed to cover services for all Johnson County clients with the excess going to the Voss House program. If Johnson County residents are seen by treatment programs other than MECCA, the County is billed for the 25% reimburse- ment. Johnson County receive billings from Lakeside, Mercy Hos- pital (CR) Chemical Dependency Unit, Droadlawns in Des Moines and several other facilities. Mt. Pleasant and Independence are funded through the Mental Health Institutional fund for which the county must reimburse the state 80% for those people unable to pay. Reality X, a chemical dependency treatment program, is funded through Title XX�the Iowa Drug Abuse authority, Linn County, and fees from individuals. It is assumed that counties will also be charged the 25% reimbursement for services to their residents who are unable to pay under the Dept. of Substance Abuse. J 0 0 22.. Oakdale is now part of the University Hospital and can accept patients on State Papers. For those individuals not on State papers, the counties are billed the 25%. Services at the Veterans Administration Hospital is limited to a 14 day detoxification program which is provided without charge to veterans. If clients need longer temm care, they are generally referred to Psych. Hospital. Veterans Hospital has no contract with them at the present time, consequently, patients must pay for services with private funds or become eligible for State papers. MECCA is considering at this point instituting a sliding fee scale for service. Citizens Committee has this in effect at the present time and in addition, has a small Title XX contract for service to lora income people. Contracts with the Iowa Division on Alcoholism are held by MECCA, Citizens Committee on Alcoholism and Lakeside in District X. The contracts are in lieu of the 75% state match, but as has been previously mentioned, do not approach this rate. Third party payments, primarily insurance, play a large part in funding substance abuse. Iowa City and University of Iowa employees are covered by a Blue Cross -Blue Shield plan which provides for payment of such services. Treatment must take place, however, in a medical facility. Out-patient or intermediate care (with the exception of Lakeside) is not covered under insurance plans. Both Lakeside and Mercy Hospital Chemical Dependency Unit rely heavily on insurance payments for reimbursement. Funding of substance abuse treatment is extremely complex and difficfilt for even professionals delivering the services to understand. Generally, it can be concluded that the very poor • . 23. can obtain services through Oakdale, Reality X, Mt. Pleasant or Independence for residential treatment. MECCA, Reality X and Citizens Committee on alcoholism for out patient or counseling services. Individuals who have adequate personal funds or who are covered by an insurance plan including substance abuse treat ment also have a wider range of treatment possibilities. It seems that individuals beyond these categories have difficulty in paying for lengthy treatment, and present problems to agencies trying to serve them. 0 0 SUBSTANCE ABUSE UNMET NEEDS Several problems, most of which have been mentioned pre- viously, were identified in the course of our study. These can be divided according to programing and facilities concerns and those which deal with the delivery system and how it works. 24. Programs F, Facilities Prevention/Education: While several agencies are to some ex- tent involved in prevention and education efforts in substance abuse in Johnson County, these efforts are not integrated and coverage is incomplete. Grant wood Area Education Agency has a values clarification/ substance abuse team to work with schools in the seven county area. These two people are made available to schools, at the schools re- quest, to conduct teacher training in these areas. Two people can- not adequately cover all schools in the seven county area, however. The team has found that schools are reluctant to invite substance abuse educators to work with them until a problem has arisen. Johnson County schools are most difficult to get into because of the number of extra people, primarily from the University, coming into the schools with various special projects. The team has found that they're asked back routinely to those schools with whom they have worked, however, they simply do not have the time to "knock on the doors" of those schools who have not used their services. Films and printed material are available to all schools regardless of whether the team has worked with them, and speakers are available to Community groups in the evening. 0 2s. The school survey of Johnson County schools, conducted in con- junction with this study, foundthatof the forty people responding, 22.5% stated that teacher training in substance abuse was adequate; 65% felt that some training was given; and 10% in regard to drug education and 12.5% in alcohol education, felt that no training was given. Other community agencies involved in substance abuse prevention and education are United Action for Youth, which works primarily in schools to which they are invited; Crisis Center, who works with both schools and community groups; MECCA; and Reality X. MECCA would like to expand its program , but has found it diffi- cult to provide the kind of education efforts they think are necessary in the schools. They do not have sufficient funding currently to permit them to do extensive work in this area. Reality X does not receive any funding from Johnson County, consequently most of their efforts are aimed at Linn County schools. Even with all the agencies involved in substance abuse prevention/ education efforts, coverage of young people is incomplete and inade- quate and coordination of these efforts most certainly is lacking. Services to the Indigent: Individuals, for whom substance abuse treatment has not resulted in a life of sobrietylpresent special pro- blems for agencies who are to help them. Many are homeless and with- out familiy ties. They require maintenance facilities, temporary or semi-permanent housing, transportation and medical assistance. Oakdale and Veterans'Administration in particular see a large number of these individuals annually. The Salvation Army Men's Social Service Center in Cedar Rapids was designed to meet the needs of these individuals, r • • .26. but find that their "work therapy" approach is not suitable for the elderly, as well as for youth. Counseling services are adequate to the extent that rehabilitation in possible, but housing or maintenance services are not available to the extent needed. Early Identification of Substance Abuses - Doctors are often times the first contact for substance abusers, yet very few patients in general medical services in hospitals are referred to substance abuse counseling. The medical profession may not be as in touch with the disease aspects of alcoholism as would be desirable. Attorneys, when surveyed, felt that on the average, 25 percent of marriage dis- solution cases involved alcohol. They, too, are in an excellent position to recommed substance abuse counseling. The Office of Planning and Programming, Highway Safety Program, views the arrest of the drinking driver as a start in.a.full.cycle of arrest, court action and rehabilitation. In Johnson County this cycle has been especially difficult to achieve because of a lack of cooperation by the courts in choosing other sentence alternatives rather than simply a $500 fine. The court has several sentence options available and can involve the Alcohol and Family Counseling Center in counseling and treatment. MECCA Alcohol and Family counseling Center desires four to six weeks of counseling sessions with O.M.V.U.I. first offenders, in- cluding the family when appropriate. It is very difficult under the present method to see a client for an hour or less and determine if he/she has an alcohol problem, based only on the information the offender submits to them. 0 0 z7. Statistics show that there were over 350 first offense O.M.V.U.I. arrests in Johnson County during fiscal 1977, 40 to 50% of those held in jail are arrested for O.M.V.U.I., due to the expansion of the ASAP (Alcohol Safety Action Program). O.M.V.U.I. arrests should increase substantially during the next year. Offenders are currently going to Kirkwood Community College in Cedar Rapids for four consecutive weeks to O.M.V.U.I. school, which is an inconvenience for the offenders. Because of the number of Johnson- County offenders (500 arrests in fiscal 1977), a program should be conducted in Johnson County. Payment for Substance Abuse Treatment: Mercy Hospital Chemical Dependency Unit.cited examples of individuals who, lacking private funds or insurance coverage to pay for substance abuse treatment, re- fused further treatment once the detoxification process was concluded. Mercy noted a direct relationship between willingness to receive treat- ment and the availability of funding. Lakeside Alcohol Treatment Center also noted that a number of people had to be turned away annually because of inability to pay for service. The very poor can receive service from Mt. Pleasant and Oakdale. Those with adequate private funds or insurance coverage can purchase services on their own: Ninety percent of the individuals seeking services from all sources were estimated to have incomes below $10,000 per year but not all are eligible for public assistance. Individuals with incomes at this level find several thousand dollars in treatment bills extremely difficult, if not impossible to pay. Programing For Youth: The prevalence of substance abuse both • • . 28. alcohol and drugs, is increasing among young people and makes up a large percentage of agency case loads. Counselors find it parti- cularly difficult to find ways to motivate young people and to aid in the development of coping skills necessary to insure sobriety. Many agencies cited the need for counseling services by individuals skilled in working with young people. The Human Services school survey pointed out that while prob- 'lems with drug usuage among young people had stabilized, 35% felt that problems with alcohol were increasing, 45% felt that the problem was remaining the same, and no one felt that the problem was decreasing.* Delivery System Concerns - Throughout the study, it became ap- parent that service providers lacked adequate information about services available through other agencies. Preventive/Education services are an.example of this. Many agencies seemed to believe that it was an- other's responsibility and that it was being taken care of by them. The result is that very little is, in fact, being done. Some of the confusion is due to the complexity of administration and funding ar- rangements. Two other areas showing lack of coordination which is causing inefficiencyor ineffectiveness in delivering services are substance abuse counseling to those in the correction system and to veterans. . MECCA had, up until recently, a counselor who worked with court services. Sixth Judicial District Department of Court Services has recently added a program of their own 'to provide that service to *20%, did not respond to this question. • • - 29. their clients. Whether this is the most efficient way to deliver services is a question which should be addressed. The Veterans'Administration Hospital will not admit an intoxicated person if there is no bed available on the psych ward, or if the ad- mitting physician sees no medical reason for hospitalizaion. This policy has caused problems for Wesley House and the Police Department who, upon request of the individual, transport him for detoxification. Oakdale also stated that because of the admission policy of Veterans! Hospital, and their lack of a long term care program, veterans who have earned' :the right to such treatment must pay -for it at another, I facility. This, too, should be examined further to prevent such prob- lems from arising in the future. Data: Accurate data was extremely difficult to obtain from agencies. Most do not keep the client characteristic information requested, and others could not retrieve that which was recorded. Because of this it is impossible to identify those portions of the population which are being underserved. 0 r' 0 0 w w N Y Y 0 > O O u Y C C •H N H co 0 d w N U UH UO U n1 ri YY YY C •H a) •H•H H •H H •H 0 td •H N •H Q H Y H >> .--1 0 H 0 HY >W >W A O A •H A b A b A cd •H O •H O O Y 7 C a 0 C O 7 Y H H H H a)n wa a.w aw av) P. CL. P. P. 00 >.>. a) >. C: Cd - > Cd u cz .H CL a) Y CL C Cl. 0) b u •H Cd u C a) C V) H H 0 H a) C O Y co H >. N O >+ Y C Y Cd P. O }. 0 0 Y F. 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N O •N F ae o 4 k •O cnukO .o N E co 00 9. k W •,1 N • �c b a+ k cd •d w U) N k a N 0) N M k 0) O w z N .'+ F 10 4J 1 0 d k •.1 W ^ C .HA O U -rq14 +•) r •rkl U w H C c ¢o z° N U. w U � H C, w F E41 d! v w k r> U O H +J P' z •H N C14 w r, ¢ w u ¢ H a w ¢ v 36. • 0 37. TO WHOM AGENCIES REFER APPENDIX A2 Mt. Pleasant iiallfw—a-y-Tious e s Reality X Vocational Rehabilitation (Education and Training) CETA (Training) Community Mental Health (Evaluation) Oakdale WI -co -holism Centers (for follow up) - MECCA Halfway Houses - Voss House Wesley House (housing after discharge) Veterans Relief Dept. of Social Services (financial) Veterans Hospital,(I:noxville) —�Clco.o Treatment enters (occasionally) Vete ransHos ital (Ioiaa Cit ) syc . ospita a itional treatment) Ve'te'rans Hospitals - Minneapolis $ Chicago (Drug in-patient treatment) Voss Recovery House (for discharge of patients and if patient is not admitted) MECCA (for recently discharged patients from the area) Crisis Center (occasionally for funds for short term housing or travel when patient is not admitted). Commission of Veterans Affairs (for funds for individual when not admitted) Oakdale (when patient is not admitted) Area Police (when patient is not admitted and becomes disorderly and disruptive) "NOTE: Patients are not admitted if no beds are available or if admitting physician feels hospitalization is not required. Lakeside Foundation nvirsity ospital, Mercy (both Cedar Rapids and Iowa City) St. Lukes, Oakdale and Veterans Administration (for detoxifica- tion under medical supervision and other medical treatment) MECCA Citizens Committee on Alcoholism and Drug Abuse AA Social Services Job Service, Inc. (reasons for referral not specified) MECCA Oakdale Hospital (Evaluation and Detoxification) Veterans Administration Hospital (Detoxification, medical and psychological services) Community Mental Health Center (psychological services) Mt. Pleasant MHI (for detoxification, long term alcoholism treatment and psychological treatment) 0 • 3E. FROM WHOM AGENCIES RECEIVE REFERRALS APPENDIX N3 Mt. Pleasant g ncies - 50% (not specified) Self referral - 500 Reality X Dept. of Adult Correction (for complementary services) Dept. of Social Services 60% of referrals come from agencies 40% of referrals come from self -referrals Oakdale ATc—oholism Centers Community Hospitals Court services Halfway House Employers School system 50% referred from agencies 15% referred from families 10% publicity Veterans' Administration (Knoxville) Alcoholism Treatment Centers 70% referrals come from agencies 20% family 10% self referrals Veterans' Administration (Iowa City) Private physician hospitals (financial reasons) Dept. of Social Services (complementary services, Veterans Organizations) Lakeside Foundation Psychiatrists Psychologists Hospitals Doctors Clergymen Iowa Division on Alcoholism MECCA SCARF (Quad Cities) Citizens Committee on Alcoholism Oakdale 60% referred by agencies or AA 20% self referrals 10% referred by family 10% publicity. Drug Abuse APPENDIX N3 (continued) • (Z) 0 MECCA Oakdale, Veterans Administration Hospital, Mt. Pleasant MHI, University Counseling Service, Courts, University of Iowa Physical Plant (employees), City of Iowa City (employees) 39. 0 0 INFLUENTIAL OR PLANNING/ADVISORY RELATIONSHIPS AFFECTING SERVICE —PRUVIDERS APPENDIX N4 Citizens Committee on Alcoholism and Dru Abuse Agency, amily an sel re err al no urt er information given) a. Who has influence over their program? b. With whom do they plan jointly or have an advisory rela- tionship? *NOTE: a denotes agency having influence b denotes planning/advisory relationship Mt. Pleasant No :Lnrormation given. RReali.ttXX a -.iowa Drug Abuse Authority b - Linn County Mental Health Centers Oakdale a - Not stated b - Halfway houses, community alcoholism centers Veterans Administration Hos ital (Knoxville) b� - Veterans A ministration Veterans Administration Hospital (Iowa City) a - Veterans Administration Lakeside Iowa Alcoholism Commission, Iowa Division in alcoholism, Blue Cross/Blue Shield of Iowa b - Consortuim agreement with all facilities in Area X. MECCA a - Iowa Division on Alcoholism b - Division on Alcoholism, County Boards of Supervisors Citizens Committee on Alcholism and Drug Abuse Not specific 4'c•. HUMAN SERVICES STUDY EMERGENCY ASSISTANCE TO RESIDENTS October 7, 1977 Emergency Assistance Sub -Committee Members: David Schuldt - Chairman Jeanette Carter Roald Rolfson Paul Sandin Margaret Stephenson Staff: Pam Ramser and Connie Echternach Johnson County Regional Planning Commission 22h South Dubuque Street Iowa City, IA 52240 yos6 TABLE OF CONTENTS Emergency Assistance to Residents GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . 2 Service Elements . . . . . . . . . . . . . . . . . . . . 2 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . 3 Families/individuals with low incomes. . . . . . . . . . 3 Victims of natural disasters . . . . . . . . . . . . . . 7 Victims of spouse abuse . . . . . . . . . . . . . . . . . 7 POPULATION SERVED . . . . . . . . . . . . . . . . . . . . . 10 Financial assistance to meet basic needs . . . . . . . . 10 Johnson County Social Services . . . . . . . . 10 Johnson County Commission of Veteran Affairs . . . . . 10 HACAP. . . . . . . . . . . . . . . . . . . . 12 Some local churches. . . . . . . . . . 12 Direct assistance to meet basic needs. . . . . . . . . . 11 Iowa City Free Medical Clinic . . . . . . . . . . . . . 11 Birthright of Iowa City . . . . . . . . . . . . . . . . it Iowa City Crisis Center. . . . . . . . . . 12 Johnson County Chapter --American Red Cross . . . . . . 12 HACAP. . . . . . . . . . . . . . . . . . . 12 Some local churches . . . . . . . . . . . . . . . . . . 12 Free Store . . . . . . . . . . . . . . 13 Emma Goldman Clinic for Women . . . . . . . . . . . . . 13 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . 15 Emergency financial assistance to meet basic needs . . . 15 Johnson County Social Services/General Relief. . . . . 16 Johnson County Commission of Veteran Affairs . . . . . 16 HACAP/Emergency Food and Medical . . 17 University of Iowa Office of Student Financial Aid/ Short-term Loan Program. . . . 18 Johnson County Social Services/County Clinical Papers. 19 Johnson County Social Services/State Papers. . . . . . 19 Some local churches. . . . . . . . . . . . . 22 Direct assistance to meet emergency needs. . . . . . . . 20 HACAP/Weatherization Program . . . . . . . . . . . . . 20 Iowa City Free Medical Clinic . . . . . . . . . . . . . 20 Birthright of Iowa City. . . . . . . . . . . . . . . 21 Emma Goldman Clinic for Women. . . . . . . . . . . . 21 Free Store . . . . . . Iowa City Crisis Center/Emergency Transportation . . . 22 22 Some local churches. . . . . . . . . . . . . . 22 Referral to appropriate agencies for emergency assistance . . . . . . . . . . . . . . 23 United Way of Johnson County . . . . . . . . . . . . . 23 Iowa City Crisis Center . . . . . . . . . . . . . . . . 23 (Emergency Assistan0to Residents --TABLE OF CENTS p. 2) UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY . . . . . . . . . 26 Provisions for emergency assistance after regular business hours . . . . . . . . . . . . . . 26 Budget Counseling/Money management services. . . . . . . 26 Assistance for victims of spouse abuse . . . . . . 27 Provision for dental services to low-income residents. . 28 Disaster assistance when less than five families are involved. . . . . . . . . . . . . . . . . . . . . . . 28 APPENDIX 1 Schedule of Allowances --Aid to Dependent Children/General Relief. . . . . . . . . . . . 29 APPENDIX 2 HACAP--Income Guidelines for Assistance. . . . 30 APPENDIX 3 Poverty Level Definition . . . . . . . . . . . 31 APPENDIX 4 Agencies which Provide Services to Residents in Crisis . . . . . . . . . . . . . . . . . . . 32 • C� EMERGENCY ASSISTANCE TO RESIDENTS GOAL The goal of interventive assistance services to residents is to ensure the provision of minimum basic necessities on a short- term basis during sudden and unexpected dislocation, emergency, or tragedy. SERVICE AREA DESCRIPTION These interventive assistance services use a crisis -oriented delivery system to meet the short-term basic needs of residents who lack sufficient resources to provide for these needs. The intervention provided is usually of a short duration and is de- signed to stabilize the immediate problem situation. Emergency assistance is given to.'.meet the immediate need for food, shelter, utilities, clothing, medical care, and transportation. Financial assistance is given and temporary employment provided to assist the family or individual in meeting the cost of basic necessities. Referral to other appropriate resources and sources of more long- term solutions is also made. Client groups include: 1) families and individuals seeking to establish residence who lack the necessary means of support; 2) resident low-income families and individuals who are temporarily in a situation of emergency financial need; 3) victims of spouse abuse (almost entirely women) who are seeking shelter from a crisis situation. /I Service Elements 1) Direct provision of basic necessities: food, clothing, shelter, transportation, medical care. 2) Financial assistance: for procurement of food, clothing, shelter, utilities, medical care. 3) Budget counseling: to encourage and instruct low-income families and individuals in wise use of limited funds. 4) Referral to other relevant sources: other services which provide for basic needs, programs which offer longer- term financial assistance and assistance designed to pro- mote self-sufficiency. 0 0 3. PROBLEM DESCRIPTION Some resident families and individuals in Johnson County may be unable to provide for the basic necessities of life for themselves during times of personal and financial crisis. Residents who expe- rience such crises and find themselves in need of short-term assis- tance to see them through the crisis period include: 1) families/ individuals with severely limited incomes (below or slightly above poverty level) or temporarily without income, 2)victims of natural disaster, and 3) victims of spouse abuse, primarily women, who might be endangered by returning home and are temporarily without personal resources for basic needs. This section will examine factors which contribute to the need for emergency assistance in the above three cases: the approximate number of individuals/families involved, cost of living, level of income and related concerns. The purpose of this section is to ex- plore, insofar as possible, the extent of need for emergency assistance services to residents of Johnson County. Each of the three groups mentioned above will be discussed in terms of need. Families/Individuals with Low Incomes It is hoped that the data presented here will be of some help in identifying the number and percent of low-income Johnson County residents who, because of their financial situation, may encounter emergency financial difficulties in providing for basic needs. We have encountered difficulties in obtaining current figures on in- come levels of the county population and, correspondingly, on the number of individuals and families below or slightly above poverty 4. level. Most of the data presented below is based on the 1970 U.S. Census, the most recent available source of extensive informa- tion. Data from the 1970 U.S. Census shows that 1,218 families (7.5% of all families in Johnson County) had incomes below poverty level. An additional 4,581 unrelated individuals*in the county (45.2% of all unrelated individuals) had below poverty level incomes. A total of 8,548 individuals (13.1% of total population) in Johnson County had incomes below poverty level in 1970. A breakdown of the poverty community in the county is shown in Table 1. It should be noted that figures do not include the 6,232 students living in residence halls in 1970. The definition of poverty level which is used here is given in Appendix 3. Figures on per capita income for Johnson County and the State of Iowa for the years 1972-74 are shown in Table 2. It can be seen that Johnson County per capita income is somewhat lower than for the State as a whole. A study done at Iowa State University in 1976 showed that the consumer price index in Johnson County was the high- est in the State (122.73 percent of the average index of Iowa counties). This discrepancy between average income and cost of liv- ing levels in Johnson County would seem to make it more difficult for those in the county with lower incomes to meet the cost of basic necessities than elsewhere in the state. Unrelated individual: A person not living with relatives, but living in a ouse old entirely alone or with one or more persons not related to him/her or living in group quarters (except in- mates of institutions). L TABLE 1 • 5. Johnson County Population with Income Below Poverty Level* 1970 *See Appendix 4 for definition of poverty level. **Percent of all persons in said population group who are below poverty level *** Does not include 6,232 students living in residence halls. **** Although University Heights is commonly considered part of the urban area, its residents are counted (by the U.S. Bureau of Census) as rural non- farm residents. Sources: Iowa City Plan: Report on Population, compiled by the Department of Community Development, Iowa City, Iowa July, 1976 1977 Statistical Profile of Iowa, compiled by the Iowa Development Commission, Des Moines, Iowa, 1977 TABLE 2 Per Capita Income 1972-1974 1972 Johnson County $3,959 State of Iowa $4,297 1973 1974 $5,081 $5,344 $5,291 $5,279 Source: 1977 Statistical Profile of Iowa, compiled by the Iowa Delelopment Commission, Des Moines, Iowa, 1977 Unrelated Population Families Individuals Persons Johnson County 1,218 7.5 4,581 45.2 8,548 13.1 Iowa City 692 7.2 3,634 44.6*** 5,725 12.2 Coralville 94 6.1 538 49.2 793 13.1 Rural Non -Farm**** 241 7.8 302 47.1 1,136 9.7 Rural Farm**** .191 10.6 107 43.0 894 12.4 State of Iowa 63,956 8.9 95,208 41.6 318,605 11.6 *See Appendix 4 for definition of poverty level. **Percent of all persons in said population group who are below poverty level *** Does not include 6,232 students living in residence halls. **** Although University Heights is commonly considered part of the urban area, its residents are counted (by the U.S. Bureau of Census) as rural non- farm residents. Sources: Iowa City Plan: Report on Population, compiled by the Department of Community Development, Iowa City, Iowa July, 1976 1977 Statistical Profile of Iowa, compiled by the Iowa Development Commission, Des Moines, Iowa, 1977 TABLE 2 Per Capita Income 1972-1974 1972 Johnson County $3,959 State of Iowa $4,297 1973 1974 $5,081 $5,344 $5,291 $5,279 Source: 1977 Statistical Profile of Iowa, compiled by the Iowa Delelopment Commission, Des Moines, Iowa, 1977 • P 6. Data from the 1975 edition of Sales Management's Annual Survey of Buying Power gives an updated picture of the income levels of Johnson County residents. This data is presented in Table 3. In 1975, 21.3 percent of the households in Johnson County had incomes under $5,000. A total of 44.5 percent of all Johnson County house- holds had incomes under $10,000 in 1975. TABLE 3 Annual Household Income --Johnson County 1975 Income Range 0 - 3,000 3,000 - 5,000 5,000 - 8,000 8,000 -10,000 10,000 -15,000 over 15,000 County Total County Median Johnson County 11.9% 9.4% 13.5% 9.7% 22.7% 32.8% $333,272,000 11,170 Source: 1975 Edition, Sales Management's Annual Survey of Buying Power Additional information compiled for District X1 in March, 1977 provides comparison of Johnson County with surrounding counties on a number of factors. District X covers six counties in Iowa: Ben- ton, Iowa, Johnson, Jones, Linn, and Washington. Johnson County includes 25.5 percent of the population in District X. The median income of all Johnson County residents is by far the lowest of the six counties (Johnson County median - $4,548/average median between counties - $6,899). Although Johnson County has the lowest median ------------ 1"General Social, Economic, Demographic, and Statistical Data on Counties in District X", March, 1977. • 7. income,'it ranks fourth among the six counties in the percentage of its population receiving public assistance (ADC, SSI, disability benefits, veterans' pension). Johnson County includes only 22.6 percent of the District X population below poverty level. Victims of Natural Disasters Emergency assistance is provided to victims of natural disasters by the Red Cross when five or more families are stricken by the disaster. There is no guarantee of immediate assistance, however, when less than five families are affected. Assistance has been provided by the Salvation Army through its local service committee and by Johnson County Social Services during its office hours. How- ever, Salvation Army service committee members cannot always be reached and Social Services can only assist those individuals who meet income guidelines for general relief. Victims of Spouse Abuse The incidence of spouse abuse in Johnson County is difficult to document due to the nature of the problem. The problem is a circu- lar one. There are no agencies which provide interventive services to victims of spouse abuse, so that women are reluctant to report abuse and perhaps worsen the situation at home. Thus, there is no real documentation of the problem on which to base assessment of need. Several individuals and agencies in the Iowa City area are concerned about spouse abuse, but at present there are no compre- hensive services available to assist victims. Two sources of information which can only hint at the incidence of spouse abuse are the number of calls concerning abuse received by the Crisis Center and the number of complaints of offenses against • • 8 family and children received by the Iowa City Police Department. Police Department records do not distinguish between spouse abuse and other types of family distrubance. Crisis Center records for the period from January 1, 1977 thru June 30, 1977 show 33 calls concerning spouse abuse. Thirty of these were made by women. The majority of calls were received between the hours of 8 p.m. and 2 a.m. Crisis Center statistics are pre- sented below. Calls Concerning Spouse Abuse Received by Iowa City Crisis Center January - June, 1977 Spouse Abuse Total Contacts 33 Call-in 32 Crisis 31 Walk-in 1 I $ R 2 Male 3 Under 18 8 Student 3 Female 30 Over 18 25 non -student 27 Times of Calls Before 11 a.m. 9% 5 p.m.- 8 P.M. 9% 11 a.m.- 2 p.m. 9% 8 p.m. -11 p.m. 24% 2 p.m.- 5 p.m. 18% 11 p.m.- 2 a.m. 30% Major Problems Mentioned: Referrals Family Life 18 Police Department 3 Interpersonal 8 WRAC 3 Alcohol 7 Dissolution 6 Of the reported information on the abuser, 20 were husbands, 3 boy- friends or formerboyfriends, 3 step -fathers, and 1 father. a The Iowa City Dice Department received 01 complaints of offenses against family and children during the year from June, 1976 thru May, 1977. No arrests were made in this category of offenses, although violence was certainly involved in at least some of them. Women are no doubt reluctant to press charges against their hus- bands for several reasons: loss of financial support, shame and embarrassment, fear of possible violent consequences from the offender. The department has noted that the incidence of family disturbance in- creases in the spring. Further information on reported incidences of spouse abuse was obtained from Johnson County attorneys. A questionnaire was sent to all Johnson County attorneys in June, 1977. Of the 22 respondents, addressed the section dealing with spouse abuse. Of these 17 attorneys, 10 felt that the incidence of spouse abuse was not increasing. Only three attorneys felt that there has been an increase. A few attorneys commented that they felt the visibility of abuse was in- creasing. The number of cases of spouse abuse seen by individual attorneys -in the last year appears to vary greatly, with some having encountered none and others very frequently seeing cases of spouse abuse. Attorneys who commented felt that the majority of spouse abuse cases occur among couples in the process of dissolution. Attorneys were asked to indicate the percentage of cases of spouse abuse in which they suspected involvement of alcohol problems, drug problems, and mental health problems. The responses included no mention of drug problems. Nine attorneys felt that alcohol pro- blems were involved; six of them suspected alcohol problems in 50% of spouse abuse cases. Eight attorneys felt that mental health pro- blems were involved, four of them suspected mental health problems in 50% of abuse cases. 0 • 10. POPULATION SERVED Eight agencies and some local churches which provide emer- gency assistance to residents with financial need were asked to furnish information on the number of clients served during the past fiscal or calendar year. Data on age, sex, race, level of income, and place of residence was also requested from the agencies. Because of the variety of services offered and differences in num- bers of clients served, this information is presented below by individual agency. Johnson County Social Services --General Relief provides short- term emergency financial assistance to.residents of Johnson County. During FY 77 (July 1, 1976 -June 30, 1977), 1,440 client appoint- ments were provided. Data on the number of clients involved is not available. Most of the clients served (90%) reside in the Iowa City metropolitan area. The remaining 10 percent live in the small cities and rural areas of the county. All clients have in- comes under $10,000. Data on sex, age, and race is not readily available. Johnson County Commission of Veteran Affairs provides short- term emergency financial assistance to honorably discharged vet- erans and their families. Two hundred thirty Johnson County families (482 persons) were served in 1976. Eighty percent of those served reside in the Iowa City metropolitan area. The remaining 20 percent live in other areas of Johnson County. All families had incomes under $5,000. 0 0 11. Nearly all clients were male (98%) and white (95%). Most clients (95%) were between 2S and S9 years of age. Age ranges were as follows: 25-3S years, 50%; 36-59 years, 45%; 60 and over, 3%; and 19-24 years, 2%. Iowa City Free Medical Clinic provides health care at no cost to the patient. In 1976, 2,886 individuals were served. A total of 4,223 patient visits were made, 3,703 (88%) of these by Johnson County residents. Of the visits made by Johnson County residents, 64 percent were residents of Iowa City, 20 percent were University students, and 16 percent were residents of other areas in the county. The majority of the total population (68%) were female. Most patients (82%) were between 15 and 34 years of age. About 10 percent were under 15 and about eight percent over 34 years of age. Informa- tion on race and income level is not maintained Birthright of Iowa City provides for emergency needs of women who find themselves in an unplanned pregnancy and who do not have resources to provide for their needs. Assistance is provided on a smaller scale than that given by the previously mentioned agencies. Fifteen women were provided with housing for varying lengths of time during 1976. About 10 women were housed for three to five months and five women were housed for one to two weeks. No informa- tion has been obtained on the number of women to whom other emergency assistance (clothing, furnishings, etc.) was provided in 1976. About 75 percent of all clients reside in Johnson County. The remaining 25 percent live in the surrounding area. Nearly all (95%) are female and white (95%). Clients' ages range from 13 - 35 years. The majority (6S%) are between 13 and 18 years of age, with an 12. additional 25 percent in the 19 to 24 year age bracket. About 10 percent are from 25 to 35 years of age. Information on client income levels is not ascertained by Birthright. The Iowa City Crisis Center sometimes provides emergency transporta- tion locally to residents in emergency situations. A total of 70 individuals were provided with emergency transporta- tion during 1976. No further information on client characteristics is available. The Crisis Center estimates that all its clients have incomes under $10,000. Emergency transportation has been provided to both transients and residents, although the Crisis Center staff feels that most of those served in 1976 were Johnson County residents. Johnson County Chapter --American Red Cross provides relief and recovery assistance to disaster victims. Expenditures totaling $465 for FY76 (July 1, 1975 -June 30, 1976) went toward the purchase of supplies and equipment. No direct assistance was rendered. Some Local Churches provide direction assistance in the form of food, shelter, clothing, and/or financial assistance for food, shelter/rent, clothing, and medical care to residents who need assistance. About 20-25 individuals received assistance from 17 churches in the Iowa City/Coralville area in 1976. Information . is based on responses to a survey done in June, 1977 from 20 of the 51 churches in the Iowa City/Coralville area. No responses were received from churches elsewhere in the county. HACAP provides weatherization and emergency food and medical assistance to residents of Johnson County. • • 13. Ninety-seven clients (a client is defined as one household or one individual served) were served by the weatherization pro- gram during the fourth quarter of 1976 (the average number of per- sons served.per quarter is 62). Sixty-seven percent of these clients had incomes below poverty guidelines (see Appendix 2 for guidelines). The majority (59%) were female. Nearly all clients served during the quarter (98%) were white. Clients of all ages were served, with the majority falling the following ranges: 22-44 years, 44%; over 65, 16%; and 6-15 years, 15%. No informa- tion is maintained on breakdown of residence within the county. Forty-eight clients were served by the emergency food and medical program during the third and fourth quarters of 1976. Sixty percent of these clients had incomes below poverty guide- lines. The majority (55%) were female. Most (79%) were white. The majority of clients fell into the following age groups: 39% of those served were from 22 to 44 years of age and 28% were from 6 to 15 years of age. Only 1% of those served were over 65 years of age. Again, no breakdown of residence is available. The Free Store provides free, usable, second-hand clothing to individuals who need it. Transients, as well as residents, use this service. The Free Store has about 100 regular users of its service. No information on client characteristics is maintained. The Emma Goldman Clinic for Women provides safe, comfortable vacuum aspirations upon request to women in the first trimester of pregnancy. Approximately 20.abortions were performed per week during 1976. No information on client characteristics was provided. Agency • Characteristics of Po u ion Served 6 14. IESIDENCE 36-59 60+ Birthright of Iowa City --- ---- 65% 251 Small Towns/ ----- Agency Johnson County Iowa City Area Rural Areas Out -of -County Birthright of Iowa City 75% -- -- 25% J.C. Commission of --- ---- ----- 2% Veteran Affairs 100% 80% 20% data in a J.C. Soc. Serv.--General Very little information on -income Agency 0-4 Relief 100% 90% 10% - Free Medical Clinic 88% 74% 14% 12% Agency 0-4 5-12 13-18 19-24 25-35 36-59 60+ Birthright of Iowa City --- ---- 65% 251 10% ----- --- J:C..Commission of 32% 68% --- --- Free Store 25% 75% 95% 5% Veteran Affairs --- ---- ----- 2% 50% 45% 3% These agencies keep their data in a slightly different manner: Very little information on -income Agency 0-4 5-14 15-19 20-24 25-34 35-59 60+ Free Medical Clinic 5% 5% 20% 38% 24% 6% 2% 0-5 6-15 16-21 22-44 45-54 55-64 65+ HACAP--Weatherization-- 6% 15% 4% 44% 7% 8% 16% Food/Medical 16% 28% 10% 39% 6% ----- 1% Agency Male Female White Non -White Birthright of Iowa City 5% 95% 95% 5% J.C. Commission of Veteran Affairs 98% 2% 95% 5% Free Medical Clinic 32% 68% --- --- Free Store 25% 75% 95% 5% HACAP--Weatherization-- 41% 59% 98% 2% Food/Medical 45% 55% 79% 21% INCOM Very little information on -income was provided by agencies. Broad estimates were given by agencies listed below. Agency Client Income J.C. Commission of Veteran Affairs Under $5,000 J.C. Soc. Serv.-- General Relief Under $10,000 Crisis Center Under $10,000 HACAP--1Veatherization-- 67% below poverty level/33% above poverty level Food/Medical 60% below poverty level/40% above poverty level is. • SERVICES PROVIDED • The services provided to residents of Johnson County with emergency need for basic necessisties fall into 3 major ;at-_gcriLs, as follows: 1) financial assistance toward procurement of basic necessities, 2) direct provision of basic necessities, and 3) re- ferral to resources which assist in provision of basic necessities. The services which presently exist in Johnson County are detailed below. Emergency Financial Assistance Toward Procurement of Basic Necessities the greatest amount of emergency assistance to residents of Johnson County is provided in the form of financial aid. Fin- ancial aid for miscellaneous basic necessities is provided by Johnson County Social Services, Johnson County Commission of Veteran Affairs, HACAP,and the University of Iowa Office of Student Financial Aid. Basic necessities for which financial assistance is given in- clude food, shelter and rent, clothing, utilities, and medical care. Occasionally assistance is given for other needs, if essential to the health and well-being of an individual (e.g. a telephone for an elderly or handicapped person who lives alone and is home -bound). Agencies which provide emergency finanial assistance rely on stated guidelines for financial and circumstantial need in order to determine eligibility for assistance. Assistance is given for a limited period of time on a one-time basis. In cases of extreme emergency, a client may be assisted more than once. Emergency financial assistance, however, is designed to alleviate an acute crisis situation and not to provide assistance to those in chronic financial need. 0 0 16. Emergency financial assistance for food shelter/rent clothing, ities, medical care, and miscellaneous needs is provided by Johnson County Social Services and the Johnson County Commission of Veteran Affairs. Many of the clients who are in need of assistance are waiting until eligibility for categorical assistance (ADC, SSI, Veterans' Pension) or unemployment can be determined. A number of clients are in search of employment and require assistance during this time. Social Services bases its determination of eligibility on in- come guidelines (see Appendix 1). The guidelines used for determin- ing the amount of assistance which an individual or family can receive under General Relief are the same as those used for ADC and are set by the Johnson County Board of Supervisors. For example, a one - member household may receive up to $145 for a one-month period; the individual's earnings for that month are subtracted from the $145 and he/she may receive aid not to exceed the resulting amount. Clients are given vouchers for food, utilities, clothing, shelter, etc. '. Maximum amounts for these specific purposes are determined according to the guidelines. Assistance for shelter cannot be applied toward damage deposits, but landlords are usually willing to work with the client to arrange payment of damage deposits and will give him/her 2 or 3 months to pay. Clients of Social Services must be residents of Johnson County but no prior period of residence is required. Families and indivi- duals who are seeking to establish residence in the county receive the same consideration for assistance as do prior residents. Social Services asks only that clients register for work at Job Service of Iowa if unemployed. Johnson County Social Services does not have provisions for 0 0 17. budget counseling except on an informal basis by individual caseworkers. They would like to be able to hire a professionnal budget counselor to talk with people before they receive assis- tance, but this is not possible at the present level of funding. There is a problem also in that clients don't see themselves as managing money poorly and are reluctant to accept help. Another problem in this area is that it is very difficult to find con- servators for those in need. No agency in Johnson County provides budget counseling/money management services on a formal basis. The Commission of Veteran Affairs assists honorably -discharged war -time veterans when they are ill or their income does not suffice to support themselves and/or their family. Determination of eligi- bility is based on the individual personal situation. Clients must be residents of Johnson County, - Financial assistance for basic necessities is available during office hours of the two agencies. No assistance is available form these or other sources on weekends or at night. Emergency financial assistance for food and medical care is provided also by HACAP. Determination of elegibility is based on income guidelines (see Appendix 2) and on emergency need. Because HACAP's income guidelines are somewhat higher than those used by Johnson County Social Services, Social Services often re- fers families or individuals whose incomes are slightly above its guidelines to HACAP for food assistance. Clients of HACAP's pro- gram must be residents of Johnson County. • • 18. Emergency financial assistance for food and medical services is available during regular business hours. Again, no assistance is available after hours or on weekends. Nearly all of the assist- ance provided is for food, rather than medical services. It would seem that the provisions available through State papers, County clinical papers, and the Free Medical Clinic suffice to meet the medical needs of most individuals in Johnson County. Financial assistance to meet the emergency needs of students at the University of Iowa is provided by the U of I Office of Student Financial Aid. Registered students may receive loans of up to $500 to assist them in meeting unforeseen expenses. A student is re- quired to have maintained a grade point average of 1.8 or above during his/her study at the University in order to be eligible for a short-term loan. He/she is also asked to specify the reason for which the loan is needed, although the particular reason given, if reasonable, is not a criterion for eligibility. Loans of up to $100 are given immediately upon application and must be repaid with the next tuition installment, within a period of one month to seven weeks. A student may receive no more than three such loans during any given year. If a loan of more than $100 is needed, the student applying must have someone who is not a student or faculty member co-sign the loan. Loans not exceeding $500 may be requested. These larger loans must be repaid within nine months. A student may be granted only one such loan during any given year. Interest is charged on all loans at a rate of 3%. Financial assistance for medical care is provided by the 19. • State papers program and County clinical papers, both of which are administered by Johnson County Social Services -General Relief. Nearly all services provided through County papers are pur- chased at U of I Hospitals and Clinics. Johnson County Social Services also has a $300/month service contract with private physi- cians at Mercy Hospital through the County papers program. County papers are used only for small bills (under $650). If a client's bill exceeds this amount, the account is switched to State papers, which are provided out of a different fund. Although aid to resi- dents who are veterans of the armed forces must be administered by the Commission of Veteran Affairs, hospital bills exceeding the Commission's quota are also provided for through State papers. The County is allotted a fixed mumber of State papers (as of July 1, 1976). Johnson County was given 20 additional slots for the Oakdale Alcoholism Unit at that time and now has 164 slots per year for State papers. Eligibility for State papers is determined by the in- come and available resources of an individual/family as compared with household expenses and the expense of treatment. ADC/General Relief guidelines are not used in awarding State papers. Johnson County Social Services makes the final decision in the awarding of State papers to residents of the County. Dental services are not covered by County clinical papers or State papers. Those individuals who are covered by Title XIX or ADC may receive emergency dental care, but the U of I Dental Clinic and local dentists do not make provisions for accepting County or State papers. HACAP had a program in the past for provision 20 of dental care to elderly persons and small children through the U of I Dental Clinic, but this is no longer in existence. It should be noted that oral surgery can be provided through County or State papers as it falls within the auspices of the Hospital and not the Dental Clinic. Obstetric and orthopedic services are provided through State papers but are quota -free (i.e. not counted into the 164 slots available for State papers). Assistance for weatherization of homes of low-income families and individuals is provided by HACAP. Insulation of homes is de- signed to reduce an individual's or family's energy costs and to lower energy consumption by 200. Determination of eligibility is based on income guidelines (Appendix 2). The client must usually own or be buying a home, although weatherization measures not ex- ceeding $500 in cost may be done on rented housing if the client cannot otherwise obtain them. Health care at no cost to the patient in a supportive environment is provided by the Free Medical Clinic to people who are unable to afford care from other sources and to those who have need of con- fidentiality in regard to care. There are no eligibility require- ments for treatment. A wide range of clinical services are provided. Clients in need of more extensive or specialized treatment are referred to University Hospitals and Clinics. The services of the Free Medical Clinic are available from 7 p.m. to 10 p.m. Monday and Thursday. The Clinic staff would like to provide more hours of service but this is not feasible at present 0 0 21. funding levels. The staff also feels that continuity of care for the patient who must return several times for the same problem is lacking due to the large number of volunteers who do not work at every clinic session. The Clinic would like to employ a nurse practitioner or physician's assistant who would be able to work at every clinic session in order to alleviate this problem. Emergency assistance for women who find themselves in an unplanned pregnancy is provided by Birthright of Iowa City and the Emma Goldman Clinic for Women. Birthright provides maternity and baby clothes, furnishings, and assistance in finding temporary housing and employment to women who decide to carry their pregnancies to term. Housing has been pro- vided during the past year for periods of time ranging from one week to five months. women are housed in private homes, most of the cost being contributed by the host. Transportation related to the above services is also provided by Birthright. Eligibility is based solely on need. Referrals are made to the appropriate resources for assistance with hospital bills (Johnson County Social Services -State papers program) and/or adoption counseling (Catholic Charities, Luthe- ran Social Service). The Birthright Office is open for three hours a day, five days a week during the University school year. Birth- right maintains a 24-hour answering service. Emma Goldman Clinic for women provides vacuum aspiration abortions upon request to women in the first trimester of pregnancy. Clients have the opportunity to discuss the abortion procedure, aftercare, and birth control with members of the Clinic staff. The client pays the full cost of the abortion, but the staff feels that cost is not a prohibitive factor in the delivery of the'Clinic's services. The 22 Clinic members feel that their abortion service and the manner in which it is provided is unique in this area. Due to a shortage of abortion services in some areas of the state, Emma Goldman Clinic must often refer women to out-of-state facilities. Free useable second-hand clothing is provided to individuals who need it by the Free Store. The Free Store is supplied entirely by donations. There are no eligibility requirements. Service is available from 9 a.m. to 10:30 p.m. Monday thru Saturday during the University school year. Emergency transportation for persons in crisis is provided by the Crisis Center. Transportation is provided in cases of drug overdose, suicide attempt, psychological breakdown, and family crisis through the use of volunteers' cars. Clients are taken to the appropriate facility, most often one of the hospitals, Wesley House, or the Crisis Center itself. The Crisis Center re- ceives a number of calls dealing with cases of spouse abuse (33 calls recorded from January -June, 1977) for which it is able to provide some intervention. However, there is no shelter facility or trained counselor in Johnson County which is specifically equipped to deal with cases of spouse abuse. Direct assistance to disaster victims in the form bf food, shelter, clothing, and medical care is available from the Ameri- can Red Cross. Relief and recovery assistance is given when 5 or more families in Johnson County are stricken by a natural disaster. The Red Cross has a 24-hour answering service. Assis- tance to disaster victims is sometimes available from the Salva- tion Army, through its local volunteer service committee. Ma- terial needs are provided through the local Salvation Army store. • • 23. Direct provision of and financial assistance for various neces- sities are available in limited amounts from some churches in Johnson County. Of 20 churches responding to a survey in June, 1977, 17..indi- cated that they occasionally provide assistance to county residents. The following table shows the types of assistance provided and the number of churches providing each type. Direct Provision of: Money for: Food 4 Food 3 Type of Aid Shelter 1 Shelter/Rent 2 Not Specified Clothing 3 Transportation/ 3 Medical Care 1 Total Served in 1976: About 25 Referral to the appropriate resources for emergency assist- ance is provided by United Way Information and Referral and by the Iowa City Crisis Center. A list of referrals for emergency assist- ance which are received and made by all relevant agencies is pro- vided on the next two pages. AGENCY Birthright of Iowa City J.C. Commission of Veteran Affairs J.C. Social Services -- General Relief Iowa City Crisis Center -- Emergency Transportation Iowa City Free Medical Clinic Free Store --Clothing REFERRALS RECEIVED FROM Other Birthrights Social Workers at University Hospital (for help in find- ing housing) Emma Goldman Clinic for Women Crisis Center (for suppor- tive services) J.C. Social Services HACAP Crisis Center Vocational Rehabilitation J.C. Commission of Veteran Affairs Job Service of Iowa J.C. Social Service workers Problem Drinking Center Voss House Local physicians University Hospitals and Clinics business office (mainly for State papers) Dept, of Adult Corrections (mainly for assistance for medical care) Contacted by other agencies when they are unable to provide such transportation Crisis Center Visiting Nurse Association of Johnson County United Way Information and Referral Wesley House Iowa City Churches M REFERRALS MADE TO J.C. Social Services (for financial aid/ State papers) Catholic Charities (for adoption counseling) Lutheran Social Ser- vice (for adoption counseling) J.C. Social Services (for food stamps/ State papers) HACAP Crisis Center (for services to transients) J.C. Commission of Veteran Affairs (for financial assistance to veterans) Social Security (for SSI, Social Security Disability) Vocational Rehabilita- tion University Hospitals and Clinics --Social Service Department Service workers at J.C. Social Services (com- plementary services) Most frequently transport clients to or from University and Psychiatric Hospitals, Union Bus Depot, Wesley House University Hospitals and Clinics (for more extensive or specialized treatment) Wesley House Crisis Center (for tempor- ary housing) Job Service of Iowa Wesley House (for temporary employment) Stone Soup (for free meals in exchange for work) • AGENCY HACAP Local Churches United Way Information and Referral Iowa City Crisis Center Information and Referral Emma Goldman Clinic for Women REFERRALS RECEIVED FRDI • 25. REFERRALS MADE TO Do not record this data. List referrals as made to "appropriate resources." Other churches Members of community J.C. Social Services University Hospitals and Clinics Crisis Center Wesley House Free Medical Clinic J.C. Social Services Iowa Memorial Union (for assistance in finding housing) Referrals made to all relevant agencies which provide emergency assistance. Referrals made to all relevant agencies which provide emergency assistance. U of I Hospitals' Early Termination of Preg- nancy Clinic Family Planning Planned Parenthood Private physicians Other clinics Refers out-of-town women to their phy- sician or clinic for pregnancy testing and a pelvic exam prior to providing them with abortion appoint- ment • 26. EMERGENCY ASSISTANCE TO RESIDE UNMET NEEDS Several areas of need in the emergency assistance service sys- tem have been identified in the course of our study. Most of these have been mentioned previously. All deserve further elaboration here. Provisions for emergency assistance after regular business hours: No assistance is available to provide for the basic needs of residents in crisis at night or on weekends. This is a problem particularly in cases of unforeseen emergency which occur after business hours or during the weekend. Johnson County Social Services does have a social worker on call at all times but is unable to make provisions for emergency financial assistance on weekends or at night. Two exceptions are noted with regard to the availability of ser- vices. Emergency transportation is sometimes available from the Crisis Center during office hours (11 a.m.-2 a.m., 7 days a week). Emergency transportation is also provided by the police department. Assistance to victims of natural disaster is available from the Red Cross immediately upon the occurrence of such disaster, if five or more families are involved. Budget counseling/money-management services: No agencies in the Johnson County area provide budget counseling or assistance with money management by a trained counselor. Informal assistance is provided to clients by some of the social workers at Social Services and to some residents of the Mark IV complex by the students that work at the Mark IV Community Center, however, clients are reluctant to accept advice in most cases and do not usually view themselves as poor money managers. Lower-income individuals are particularly in need of the assistance which a trained budget counselor could provide to help them stretch their limited resources to cover expenses. Assistance for victims of spouse abuse: There is increasing concern on the part of a number of individuals and agencies in the Iowa City area about the need for interventive services in cases of spouse abuse. As previously stated, the Crisis Center received 33 calls from January 1 through June 30, 1977 for assistance in cases of spouse abuse. Other agencies involved with cases of abuse are the Community Mental Health Center and the Police Department. The incidence of spouse abuse in the area, as previously mentioned, is difficult to document. Since there is no agency which offers the needed intervention, women have no central place to report and no place from which to seek help. Victims are often reluctant to re- port the situation to the police or Crisis Center due to fear of worsening the consequences at home as a result. Spouse abuse is difficult to document as a result, although it is a problem area which needs attention. There is a need for services which would pro- vide immediate and intensive measures for alleviating the abuse and attempting to prevent future occurrence of abuse. Programs in other areas of the country offer immediate shelter to the abused individual and/or immediate, intensive counseling therapy involving both the abuser and the victim. Therapy is aimed at reconciliation through identifying the root problems leading to abuse and exacting commitments to change of specific behaviors from both parties. Shelter services are geared to end the immediate case of abuse by separating victim and abuser and providing a pro- tected,*supportive environment for the victim. No comprehensive service exists for intervention in cases of spouse abuse exists in Johnson County. 0 • 28. Provision for dental services to low-income residents not receiving categorical assistance: One area of need which is not covered by County clinical papers or by any program is dental services. Neither the U. of I. Dental Clinic nor local dentists provide services to low-income people through the County clinical papers system. There is no means at present through which indi- gent people can receive dental services if they are not receiving categorical assistance. Need for assistance in cases of disaster which involve less than 5 families: There is no guarantee of immediate provisions in cases where less than 5 families are stricken by natural disaster. The Red Cross is responsible to provide assistance only in situa- tions of natural disaster which involve 5 or more families. Social Services will provide for persons who meet income guidelines, but immediate services cannot be provided after business hours or on weekends. Assistance has been provided by the Salvation Army, through its local volunteer service committee, but volunteers can- not always be reached, so that assistance_ is not always immediately available. The family or individual who has lost everything in a natural disaster involving less than 5 families sometimes is left without any source of needed emergency assistance. • • 29. APPENDIX 1 State of Iowa Department of Social Services SCHEDULE OF ALLOWANCES - AID TO DEPENDENT CHILDREN/GENERAL RELIEF Number ofach Persons 1 2 3 4 5 4 7 8 9 Addition z pA snn Amount 145 222 294 356 415 456 518 576 621 1 69 CRART TOR DETERMINING INCOME IN KIND ADC (All figures are on.a per person basis. Number of Persons 1 1 2 3 4 5 6 7 8 9 Shelter 41.50 25.50 24.25 21.00 18.00 15.25 14.00 12.75 11.50 Utilities 22.50 14.50 11.75 9.75 8.50 6.75 6.50 6.25 5.25 Supp & Repl. 9.50 5.50 4.00 3.25 3.00 2.50 2.25 2.00 1.75 Food 39.00 35.25 33.75 32.25 31.25 30.00 30.00 30.00 130.00 Clothing 11.25 11.25 11,25 11.25 11.25 11.25 11.25 11.25 11.25 Per. Care & Supp. 6.75 6.75 6.75 6.75 6.75 6.75 6.75 6.75 6.75 Med. Cab.Supp. 1.50 1.50 1.50 1.50 1.50 1.50 1.50 1.50 1.50 Communications 13.00 7.75 4.75 3.2 2.7 2 1/75 • • APPENDIX 2 HACAP - INCOME GUIDELINES FOR ASSISTANCE ON ENERGY BILLS 30. FAMILY SIZE NON-FARM FAMILY FARM FAMILY 1 $3,713 $3,188 2 $4,913 $4,200 3 $6,113 $5,213 4 $7,313 $6,225 5 $8,513 $7,238 6 $9,713 $8,250 For family units with more than six, add $1,200 each for non- farm and $1,013 each for farm families. 7/12/77 APPENDIX 3 POVERTY LEVEL' DEFINITION* BY U.S. BUREAU OF THE CENSUS: WEIGHTED,AVERAGE THRESHOLDS BY NONFARM E FARM RESIDENCE' 1970 NOTE: From Iowa Cit Plan: Rc�ort on lation; Department of COumiunity Development, City o owa City, owa; u y,11"909N • El w N NONFARM** FARM SIZE OF FAMILY UNIT TOTAL MALE FEMALE TOTAL MALE FEMALE HEAD HEAD HEAD HEAD All unrelated individuals $1,840 $1,923 $1,792 $1,569 $1,607 $1,512 Under 65 years 1,893 1,974 1,826 1,641 1,678 1,552 65 years and over 1,757 1,773 1,751 1,498 1,508 1,487 All families 3,410 3,451 3,082 2,954• 2,965 2,7.57 2 persons 2,383 2,394 2,320 2,012 2,017 1,931 Head under 65 years 2,458 2,473 2,373 2,093 2,100 1,984. Head 65 years and over 2,215 2,217 2,202 .1,882 1,883 1,861 3 persons 2,924 2,937 2,830 2,480 2,485 2,395 4 persons 3,743 3,745 3,725 3,195 3,197 3,159 S persons 4,415 4,418 4,377 3,769 3,770 3,761 6 persons 4,958 4,962 4,917 4,244 4,245 4,205 7 or more persons 6,101 6,116 5,952 5,182 5,185 5,129 *The definition of Low -Income or Poverty Level was established by the Social Security Administration in 1964 and modified by the Federal Interagency Commission in 1969. It is revised annually to reflect changes in the Consumer Price Index. Low -Income Level thresholds are based on a nutritionally adequate "economy food plan" designed by th-e Department of Agriculture for "emergency or temporary use when funds are low". These thresholds are adjusted by family size, age and sex of head, number of children and farm or nonfarm residence. The chart above shows thresholds for nonfarm residents only. **Includes urban. NOTE: From Iowa Cit Plan: Rc�ort on lation; Department of COumiunity Development, City o owa City, owa; u y,11"909N • El w N APPENDIX 4 AGFICIES Milal PROVIDE SERVICES ID RESIDENrS IN CRISIS (usually financial) SERVICES PROVIDED ELIGIBILITY R 1,f I FMI _t 32. Birthright of Iowa City Maternity and baby clothing, furnishings, Any woman, regardless of race, creed, Per this and counseling/ Social Services/General assistance in finding tempomry housing and marital or economic status who finds support services: clothing, medical care (State papers, county employment; provision of transportation re- herself in an unwanted or unplanned 1976 - $ 2,843 tial and circumstantial need. Clients lated to above services. Service available pregnancy may receive assistance. No fees are charged; membership is Sources: Donations, at office 3 hours per day, 5 days/week and by phone at all times. 15 women provided with voluntary for clients ($1.00 to be- of Iowa if unemployed. Membership fees housing for varying lengths of time. cane a member, $2.00 to becane a mem- ber and receive the newsletter). Johnson Canty Commis- Financial assistance for food, rent/shelter, Furst be honorably discharged veteran Including services to tran- sion of Veteran Affairs utilities, medical care, and miscellaneous and meet guidelines for financial sients: items. Services available 8 Iters/day, 5 days/ and circumstantial need. 1976 - $75,600 week. 230 Johnson Canty families (482 per- 1977 - $75,600 sons) served in 1976. 1978 - $80,850 Source: J.C. Board of Supervisors (1001) Iowa City Crisis Center Emergency transportation to the proper faci- None. 1976 - $ 1,198 lity (hospitals, Wesley (louse, Crisis Center) 1977 - S 645 for persons in crisis (drug overdose, sui- 1978 - S 686 tide attempt, family crisis, psychological Sources: J.C. Board of breakdown) through the use of volunteers' Supervisors (641) cars. Service available from 1.1 a.m.-2 a.m., seven days a week. 70 individuals served in United Way (281) 1976. Work/Study (41) Donations (31) Misc. (11) • Johnson County Dept. of Emergency financial assistance, usually one- Fiust be resident of Johnson County (no July 076 -June '77 - $37,226 Social Services/General time only, for food, rent/shelter, utilities, specific period of prior residency re- rY 118 - 598,700 Relief clothing, medical care (State papers, county quired) and meet guidelines for finan- Source: J.C. Board of • clinical papers), and miscellaneous items. tial and circumstantial need. Clients Supr visors (1001) Services available from 8 a.m.-4:30 p.m. Mon- are asked to register with Job Service day through Friday. 1,440 client appointments of Iowa if unemployed. during rY 1977 (July, 1976 -June 30, 1977). AGea Salvation'Army- I.ocal Volunteer Service Committee Iowa City Free Medical Clinic Free Store Johnson Canty Chapter - American Red Cross SERVICIS PMMID Relief and recovery assistance to disaster victims; provision of mnterinl goods throught local Salvation Army Store in cases or disaster. Ilenith care in a supportive environment at no cost given to people who are unable to afford other health care and to those who have need of confidentiality in regard to care. Ser- vices available from 7 p.m. -10 p.m. on Mon- days and Thursdays. 4,223 patient visits (2,886 individuals served) in 1976. 3,703 patient visits by Johnson County residents. Free, usable second-hand clothing to those who need it. ]lave provided other items in past, but this service discontinued in July. Services available from 9 a.m.-10:30 p.m., Monday -Saturday when Center Fast is open (about 11 months/year). About 100 regular users; about 12 clients/day visit the store (3,432 visits/year). Disaster preparedness, relief and mcmery to disaster victims; provision of food, clothing, shelter, medical assistance when 5 or mom families are stricken by a natural disaster. ELIGIBILITY None. None. None. Provided to all victims of natural disaster when 5 or more families are stricken. 33. 1976 - $21,096 1977 - $25,290 1978 - $30,100 Sources: United Way (501) J.C. Boardof supervisors (351) • Private groups and individuals (151) Nene. Clothing donations only. FY 1976 - S 465 • AGENCY SERVICES MYVIDM ELIGIBILITY U of I office of Student Loans given to help students meet unforeseen fust be student at U of I and hove Financial Aids --Short-term expenses: up to $100 without co-signer, up to grade point average of 1.8 or above. Loan program $500 with co-signer. IIACAF - Neighborhood a) Weatherization program for low -intone people. a) lust be below poverty guidelines (AF - Center 97 clients (1 client -1 household or 1 indivi- pendix 2) and am or be buying a hare. dual) served in 4th quarter of 1976. Average If renting and weatherization unavail- quarterly total • 62 persons. able through other sources, up to $500 worth can be provided. b) Emergency financial assistance for procurement b) lust be below proverty guidelines (Ap- of food and medical assistance. 48 clients peadix 2) or be in situation of amer. served in 3rd and 4th quarters of 1976. - gency need. Local Churches Sane churches provide food, shelter, clothing, None. financial assistance for food, shelter/rent, clothing, and medical care to residents who need assistance. Limited amounts of assistance provided. Emma Goldman Clinic Abortions during the first trimester of None. for Women pregnancy and referral for abortions 34. FUNDING Amount (7) Source: University of Iowa (100%) For 5 -county area, including Johnson County: 1978 - $102,265 Sources: Community Services Administration (Federal -63%; Local -37%) July '77 -June '78 -- $20,000 Source: Community Services Administration (Federal•1001) Church funds. Limited re- sources available. Amount (7) Source: Client fees • HUMAN SERVICES STUDY PROTECTION OF THE ELDERLY FROAf ABUSE, NEGLECT, AND EXPLOITATION PROFILE October 7, 1977 TABLE OF CONTENTS Protection of Elderly Adults from Abuse, Neglect, and Exploitation GOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SERVICE AREA DESCRIPTION . . . . . . . . . . . . . . . . . 1 Service Elements . . . . . . . . . . . . . . . . . . . . 1 PROBLEM DESCRIPTION . . . . . . . . . . . . . . . . . . . . 1 Definitions of abuse, neglect, exploitation. . . . . . . 1 Statistics on elderly population in Johnson County . . . 2 POPULATION SERVED . . . . . . . . . . . . . . . . . . . . . 3 Department of Social Services Protective Service Unit. 3 MECCA. . . . . . . . . . . . . . . . . . 4 xq State Health Department. . . . . . . . . . home 4 4 Council on Aging (nursing complaints) . . . . . . . Iowa'City Police Department. . . . . . . . . . . . 4 Council on Aging (reported rapes). . . . . . . . . . . . 5 Heritage Agency on Aging Legal Services. . . . . . . . . 5 Attorneys. 5 SERVICES PROVIDED . . . . . . . . . . . . . . . . . . . . . 6 Advocacy for the Protection of the Aged. . . 6 Council on Aging . . . . . . . . . . 6 Health Standards Monitoring. . . . . . 6 Department of Health . . . . . . . . . 7 Department of Social Services. . . . . . . . 9 ,Care Review Committees . . . . . . . . . . . . . . . . 10 Summary. . . . . . . . . . . . . . . . Aid Counseling . . . 11 12 Legal and . . . .. . . . . . Heritage Agency on Aging Legal Services. . . 12 Hawkeye Legal Aid Services . . . . . . . . . . . . . . 13 UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY . . . . . . . . . 14 ' Potential service population . . . . . . . . 14 Abuse, ngelect, and exploitation by families . . . . . . 14 Medical personnel . . . . . . . . . . . . . . . . . . . . 15 Fraud. . . . . . . . . . . . . . . . . . . . . . . . 15 Nursing homes. . . . . . . . . . . . . . . . . . . 15 Legal rights to services . . . . . . . . . . . . . . . . 16 Data collection . . . . . . . . . . . . . . . . . . . . . 16 APPENDIX Services Provided . . . . . . . . . . . . . . . . 17 PROTECTION OF ELDERLY ADULTS FROM ABUSE, NEGLECT, AND EXPLOITATION GOAL The goal of this service area is the promotion and preserva- tion of conditions that enable elderly individuals to live in an environment where they feel safe, are protected from physical abuse, neglect and exploitation and can manage their daily lives with assistance as needed. SERYTCE AREA DESCRIPTION The programs in this service area are designed to protect, by legal I> intervention and provision of social services, individuals whose physical and/or mental capabilities are so limited as to endanger them and/or allow them to become easy victims of exploitation by relatives and others. Service Elements: Advocacy for the protection of the aged, health standards monitoring, legal aid and counseling. PROBLEM DESCRIPTION In our discussions with personnel of agencies which serve the elderly population, it was difficult to define abuse and neglect. Definitions ranged from the formal Department of Social Services definition to the absence of corrective action by agencies or indivi- duals. The Department of Social Services defines adults in need of protection as "those adults who are unable to protect their own interests or who are harmed or threatened with harm through action or inaction of another individual or through their own actions due to.ignorance or poor health; resulting in physical or mental injury, neglect or maltreatment, failure to receive adequate food, shelter • 0 2. or clothing, deprivations of entitlements due them or diminution of resources." Other definitions of abuse, neglect or exploitation included: 1) Neglect - placement in improper level of care 2) Abuse - taking away of dignity 3) Exploitation by families 4) Lack of discharge planning 5) Emotional abuse 6) Negative attitudes among legislators or service providers 7) Failure of agencies to seek out elderly who are in need of but who are not receiving care because of their lack of awareness of community resources, their reluctance to ask for aid, or their unwillingness to admit to having a need. Few of these definitions connote offenses for which legal prosecution would result. However, the effect of these offenses upon a dependent population could be very serious indeed. The over -65 population of Johnson County was 4,812 or 7.07 + percent of the total population in 1970. This compares to about f 13ercent of the Iowa state p population over 65. The percentage of the population in Iowa City which is over 65 (6.6 percent) is lower than that in rural Johnson County (8.8 percent). In 1970, 3.7 percent of Coralville residents and 13.2 percent of University Heights residents were over 65. In Johnson County, 13.1 percent of the total population in 1970 had incomes under the poverty level. Of these, 12.1 percent were elderly (8,548 poor; 1,034 elderly poor). Of the total popu- 3. lation over 65, 22.5 percent was below the poverty level; this is almost twice the percentage of poor in the non -elderly population. It is estimated that in Iowa, eight percent of those over 65 are in institutions.l The number of Johnson County elderly in nursinghomes is not available, however, there are approximately 700 intermediate and residential beds in Johnson County. Eight percent of those over 65 in Iowa are totally housebound; 25 percent of those over 65 live alone or with non -relatives. In addition to the housebound and institutionalized elderly in Iowa (16 percent), many elderly living in families or alone could be considered dependent (unable to manage their daily living) as well. There is a great range of different levels of dependency and there- fore a variety of protective services are needed. POPULATION SERVED The Department of Social Services Protective Service Unit has 28 cases currently (August, 1977). Ten are elderly persons. Spouse abuse (long-term situations continued from earlier years) is the most frequent form of victimization of the elderly found by the Department. The second most frequent form of victimization is abuse by family members. The Department has no legal authority for.the provision of services to abused or neglected elderly, as with abuse and neglect of children cases, the abuser may be the legal guardian of the elderly person. The Department cannot enter the home where the abusive person is housing the elderly client without consent of the adult responsible for thAd client. The.third most frequent form of victimization is nursing home abuse. The Department has not had a substantiated nursing home Health Services Agency State Plan complaint in the last four years; nursing home complaints must be turned over to the State Department of Public Health. The Department of Social Services has received no elderly rape cases in the last few years. Many elderly do not favor "protective" services because they, do not want to be declared "incompetent". The dilemma of pro- viding protective services is found in making them available when needed while ensuring that the individual's dignity and right are preserved. MECCA has dealt with some spouse abuse cases involving elderly couples. The annual report for their aging project stated that alcohol contributed to spouse abuse in some of the cases in the four -county area which the 'agency serves. The State Health Department recordsfor the last year show that five nursing homes patient -care complaints were reported in Johnson County during this time. One of these complaints was substantiated, one is currently pending investigation, and three were.unsubstantiated. The Council on Aging reported that many of the nursing home problems of which it is made aware are so subtle that it is dif- ficult to substantiate them as bona fide complaints, (e.g. a blind person not getting the same food as others). The Iowa City Police Department lists one attempted rape (age 80) and one rape (age 55) case with older victims out of six re- ported rapes and five reported attempted rapes in the first seven months of 1977 (some of the ages of the victims, however, were not given). Financial fraud against the elderly was identified by the police as a major concern. The Council on Aging reported one rape and one attempted rape (which were not reported to the police) of women over age 60 during the first seven months of 1977. The Council on Aging director feels that the official record is an underestimation of the actual occurrence of rape of elderly persons. Heritage Agency on Aging Legal Services has served about eight Johnson County cases involving exploitation during the period from October, 1976 thru August, 1977. Four of the 20 attorneys responding to a survey in June, 1977 said that they had seen cases of abuse or neglect, as "broadly defined", in the past year. Two attorneys said that they refer such cases to the Department of Social Services. • SERVICES PROVIDED 0 6'. Protection of the elderly from abuse, neglect and exploi- tation are provided through three services: Advocacy for the Pro- tection of the Aged, Health Standards Monitoring, and Legal Aid and Counseling. Advocacy for the Protection of the Aged Advocacy for the protection of the aged is designed to plead, argue, or urge the case for the provision of special protective measures for the aged, the infirm and the handicapped person who is in danger of neglect, abuse, exploitation or some other harm. Program elements include development of materials and communica- tion of arguments to select parties or the public -at -large. The Council on Aging comes in contact with elderly who may be abused, neglected, or exploited through their friendly visiting program, shoppers' aid, and Senior Center activities. Thirty-three individuals were visited in their homes by volunteers last year. The shoppers' aid program helped 45 elderly by running errands or escorting them to shopping facilities. In both of these situations the.volunteer develops a personal relationship with the slderly in their homes. If volunteers detect abuse or neglect, the Cen- ter's staff is notified and follows up on the problem. The staff gives elderly persons an opportunity to discuss problems at Center activities. They also provide guidance and advocacy through the Information and Referral program and the Advocacy program. The In- formation and Referral program served 1,747 individuals during fis- cal 1977 (July 1,1976 -June 30, 1977). Health Standards Monitoring Health standards monitoring is designed to protect consumers of health services from health hazards and less•than professional services. Program elements include investigation of complaints, inspection or cancellation of licenses or accreditation where such 0 0 7. authority exists, and general monitoring of compliance with standards. Three organizations are charged with reviewing the care which individuals receive in nursing homes: The Iowa Department of Health, The Department of Social Services, and Care Review Committees at each facility. Information on these organizations is taken from the Care Review Committee Manual published by the Iowa Commission on Aging. DEPARTMENT OF HEALTH: Annual unannounced licensure inspections of health care facilities are to be carried out by the nurse consultants of the Consultation and Licensing Divi- sion of the Department of Health.. During such inspec- tions, all records (dietary, personnel, etc.) are open to the nurse consultants. Attempts are also made to talk with some of the residents to gain their input as to the facility's condition. Upon inspection, if a nurse consultant finds a facility to be in violation of the state law and/or regulations, a conditional license may be issued. Along with this a grace period of thirty days, sixty days or one year depending on the severity or extent of the violation is extended to the licensee to remedy the conditions. On-site follow-ups are then done to see if violations have been corrected. While consultation and education are viable and impor- tant ways to help bring health care facilities into compliance with state rules and regulations, they are not always sufficient to enforce compliance. In 1975 the Iowa General Assembly passed legislation, effective January 1, 1976 implementing a fining and citation system for health care facilities. The system classifies vio- lations of Department rules and regulations into three classes depending on severity, duration, intent and recurrence of the condition. Facilities are fined accordingly. Facilities have the right to judicial re- view of any citation and fine levied for which they feel there was not just cause. The maximum time allowed for the correction of violations is one year; a health care facility may operate under a conditional license for no more than one year. If, at the end of time, the violation still exists, the in- spector is to recommend revocation of the license. In some instances waivers may be issued to a home failing to meet a particular standard provided that it does not 8. hamper patient care or the delivery of services. Re- vocation of a license may be recommended upon an inspection if conditions in the home are so poor that the physical plant and/or patient care jeopardize the health and safety of the residents. The nurse consultant is in the position to recommend rather than act on the revocation of a license; the ultimate power to revoke a license lies with the Com- missioner of Public Health. If this process is carried out, the Commissioner of the Iowa Department of Social Services becomes involved and must withdraw Medicaid - Title XIX funding from that home. If the recommendation for revocation of a license is made, a notice of same is sent to the licensee, listing the deficiencies in the home. It notifies the licensee of the right to appeal the action and allows thirty days for a hearing at which time evidence may be presented on both sides, as to why the license should or should not be revoked. The hearing officer who presides over the appeal is appointed by the Commissioner of Health. If the licensee chooses not to appeal the decision, the license is revoked on the date stated on the revocation notice and Medicaid funds are withdrawn. However, if an appeal is requested, the facility remains open unless the appeal results in a decision for closure. If an appeal is sought, all reasons for which revocation has been recommend- ed are subject to public disclosure. However, if the Commissioner believes that conditions in a home present a danger to its residents, he may ask that the local Care Review Committee go into the home and survey the situa- tion, and if the committee recommends, he may close the facility prior to the appeal process. He also has the power to close a home of his own accord if he is of the opinion that such expedient action must be taken to pro- tect the residents. In addition tothe annual inspection, special investigations and inspections regarding specific complaints received bythe Division of Health Facilities are carried out by the Consulation and Licensing Division. The Division investigates all complaints received. The identity of the party issueing the complaint is not to be disclosed to the facility's administrator unless the complainant wishes to be acknowledged. The department prefers that complaints be submitted in written form with as much documentation as possible. The Department of Health has a contract with the Department of Social Services to perform the latter's ICF (Intermediate Care Facility) surveys required for home to be certified to accept Title XIX -Medicaid patients. The ICF program is federally funded, limiting its inspection to nursing homes and hospitals. State ICF rules were written in accordance with federal guidelines. DEPARTMENT OF SOCIAL SERVICES: Annual review of Title XIX (Medicaid) patients is carried out, according to federal guidelines, by the State Depart- ment of Social Services. The Division of Long -Term Care in the Department of Social Services has review teams that were sent into operation in April of 1973. The func- tion of these teams is to visit every skilled and inter- mediate care facility in Iowa that has Title XIX patients, and to interview all residents receiving Title XIX medical assistance. As a result of their findings, the review teams make recommendations to the nursing home licensee on improving conditions for a specific patient. Each of the review teams consists of a registered nurse and social worker. Each has available a consulting physi- cian. The team's training consists of an orientation during which they study basic regulations, procedural guidelines for conducting a survey, social work theories and atti- tudes in aging. The survey of a nursing home involves a separate interview with each resident of the home who is receiving public assistance. The interview is geared toward whether or not the human needs of these people are being met; a review of the medical records is made and the residents' situation is discussed with the administrator. A review of the home's physical condition and its programs is made. An attempt is made to determine whether an individual is appropriately placed in that facility. The team helps the home find and use community resources for the improvement of the home. From the findings, the team makes recommendations to the administrator in terms of what can be done to improve the situation of a Parti- cular patient. These written recommendations to the administrator are also given to the county department of,social services. Reviews noting deficiencies re- quire response by the adminstrator to the review team. If a particular home is found to be providing inadequate care and is in gross violation of health care standards, the Director of Long Term Care may contact the Depart- ment of Health about that home and request a survey to determine if Medicaid (Title XIX) funding should be withdrawn. Medicaid funding must be withdrawn when- ever a facility's license is revoked by the Department of Health. Federal law requires at least one yearly review of each Medicaid resident and facility by a review team. No advance notice is required for team visits. In some cases, an unannounced folow-up visit is made in order to see if the recommendations made upon the first visit have been acted upon. Any changes in the facility, its prograTs, or numbers of staff are also noted at that time. ZCare Review Committee Manual, Iowa Commission on Aging, pp• - U CARE REVIEW COMDIITTEES (CRC) Each health-care facility is required to have a CRC to periodically review the needs of each resident of the facility. Members of the CRC,s are artmentaofoi ted by If Commissioner of the State Dep s after the Commissioner fails to act within thirty days or a notification of a vacancy by the facility, th e facility administrator may make unsatis- appointment. A CRC found ben functioning may be factorily by the State Depart ointments. required to place such membership by new a P The Care Review Committees (CRC) should act as consumer advocates for the resident and make recommendations for the improvement of care and services in his behalf. They should be a facility, thebetween facilityhe residents of a administrator, and health-care facility, provided no conflict of in - the community. Any person, terest exists, with an in in health-care be appointed and the protection of dependent persons may PP to serve. in The members of the CRC shall of haveed own employee ore facility be employed by involved with the the licensee' nor a public employee sponsoring or placement of residents' or who inspects or otherwisf evaluates the health-care facility or residents. ility are to be reviewed annually All residents of the fac by members of the CRC. An evaluation form shall be filed with the administrator of the facility. The committee is to be concerned with the physical, spiritual, personal, and social needs of the individual resident and to determine whether the facility is fulfilling the contract for services and programs for care as agreed upon in the resume of care. "The CRC members may recommend that a resident be trans ferred due to inability or failure of the facility to pro- vide services needed by the resident." 4 • 10: 3Ibid., p. 7 4 Ibid., p• 9 0 0 The following responsibilites of the CRC with regard to complaints are outlined below: 1. When a complaint is received by the Department of Health, the department or Care Review Committee shall make pre- liminary review of the complaint. If the department wishes the CRC to do a preliminary review of a complaint the committee chairman shall be informed by phone and follow-up letter. 2. The Department of Health may refer to the CRC of a faci- lity any complaint received by the department regarding that facility for initial evaluation and appropriate action by the committee. In any case, the complainant shall be promptly informed of the result of any action taken by the department or committee. 3. 11. All complaints received by the committee regarding nurs- ing care and dietary (other than, I don't like the food) should be forwarded to the department. Discretion should be exercised by the committee as to when professional judgment is necessary and what constitutes a formal complaint. If upon an inspection of a facility by its care review committee, the committee advises the department of any circumstances believed to constitute a violation the committee shall similarly advise the facility. The committee may request that the complainant or his/her representative or both be allowed the privilege of accom- panying the inspector during an on-site inspection. 6.. Advice and consent of the CRC is required for the Com- missioner of the Department of Health to remove all residents when he finds that the health or safety of residents of the health-care f?cility requires such action on an emergency basis. Summary The monitoring organizations should provide adequate opportunity for complaints to be voiced and rectified problems exist, however, with this system. 5Ibid. , p. 9 Several • • 12: 1. There is no provision made for relocating an indi- vidual who is not receiving proper care. The availa- bility of beds for Title XIX recipients in nursing homes is limited. Disruption of the life of an elderly person is also a factor which must be con- sidered. 2. The Care Review Committee operates primarily at the discretion of the facility administrator and is dependent upon his/her guidance. Few Care Review Committees are actively working to guard the inte- rests of the patients in facilities on an on-going basis. On-going contact with elderly patients is required if the CRC member is to gain the trust and confidence of the patient. 3. The linkage of these three monitoring organizations is unclear, as is the willingness of the Health Department to take the recommendations of the CRC's and Care Review Teams. Legal Aid and Counseling Legal Aid and Counseling programs assist eligible low income or elderly persons by providing information, Coun- seling, and defense in civil matters. Those who cannot meet the cost of retaining a private attorney may receive legal representation before some administrative, quasi- judicial or judicial tribunal. The Heritage Agency on Aging Legal Services for the Elderly provides legal services to elderly persons who cannot n afford or do not have access to legal help through a three- ` pronged program which involves assistance by the agency's attorney, paralegals, and referral to private attorneys. The agency's attorndy gives legal advice and answers ques tions regarding wills, probate, income and property taxes, social security and SSI, housing and landlord tenant relations, insurance, guardianships and conservatorships. • 13. The staff of Heritage Agency advises the elderly of their legal rights and handles administrative (SSI, Social Security, food stamps, IPERS) appeals. For those cases which are fee - generating (e.g. wills, conservatorships, legal suits involv- ing claims for damages) the individual, if low-income, is re- ferred to Legal Aid or to an attorney who has agreed to work for a reduced fee. The program director has seen about eight Johnson County cases involving exploitation since October, 1976. These cases generally involved exploitation by families or nursing homes. A total of 475 Johnson County clients were served through the Legal Services for the Elderly program in 1976. Hawkeye Legal Aid Services provides legal counseling, advocacy and representation to low-income people through a staff attorney system. Approximately 5 percent of the John- son County elderly population (about 25 individuals) was ` served during 1976. The Legal Aid Services can deal only with civil matters and cannot become involved in criminal prosecution. 0 14. UNMET NEEDS .Potential Service Population - In the 1977 Iowa City Citizen's ___ _Survev section on human services, the most clearly identified priority was increased attention to services for the elderly. Of the res- pondents, 41.7 percent saw the elderly as first in importance in planning for new or improved services in the community. Services to the elderly living alone was seen as "Definitely" needed by 34.3 per- cent of the respondents. It was ranked second in importance after information and referral. The next highest was Day Care for the Elderly where 29.9 percent said "Definitely and 39.8 percent said it was "Probably" needed. Examples were given by individuals working with the elderly of abuse,neglect and exploitation. Those examples centered around four main areas: families, medical professionals, nursing homes, and — fraud or "bunco artists." Abuse, neglect and exploitation by families was one of the more common situations cited. An individual spoke of families who took over the elderly person's home or expected an elderly person to do chores ,in exchange for a domicile. Physical abuse or neglect were also mentioned. The Council on Aging stated that children "dump" their parents at tfie Close Mansion, delegating responsibility for (heir care to the agency. SEATS personnel cited 4 or 5 cases of children placing their parents prematurely or unnecessarily in institutions. MECCA also found spouse abuse among elderly couples with a history of alcohol involvement. Abuse or neglect in the home cannot always be followed up. The family can refuse admittance to an investigation under these circumstances, unlike child abuse cases. Abused elderly know the possibility of retribution and will not disclose acts of ' neglect they suffer at the hands of their children. Medical Personnel may not be as sensitive and responsive to the special needs of the older person as is necessary. An example of this is in the medication given and in the instruction on how to take the medication. The Health Service Agency Plan reports that "drugs are given far too readily with inadequate consideration for the changing physiology 1. • . 15. o�the aged." Individuals contacted as part of our study were concerned that proper and patient instruction be given on how to take medication. Some elderly are afraid of taking an overdose and as a result do not take enough, while others overdose because they are confused about the proper amount or cannot remember if they have taken it already. The Health Services Agency Plan recom- mends that "careful periodic review of all drugs prescribed for each patient is critical. Patient awareness of common errors in self-medication must be heightened. It was also felt that impatience on the part •of"medical personnel'and the long wait required prior to being seen by the physician, particularly at the University Hospital, may put the health of the elderly in jeopardy. Fraud - A police officer felt that the elderly were a prime target of crime in the community. Burglarly, mugging and fraud com- mitted against the elderly are serious problems. He stressed the need for preventive and crime awareness programs. Nursing Homes - A great deal of discussion centered around abuse and neglect of residents in nursing homes. Examples were given of slapping, forcing food too quickly for the patient to swallow, cold food being served and people being dropped into chairs. Placement of the individual in the proper level of care was also of concern. Three separate mechanisms have been established to monitor the care of patients: the Care Review Team from the Department of Social Services,,Dept. of Health Consultation and Licensing Division', and the Care Review Committee at each facility. Violations may result in revocation of the license by the Health Dept. Few cases of abuse or neglect have been reported or verified, however. The elderly are, however, often too afraid of these "advo- cates" to report abuse or neglect. The relationship between the Care Review Team and nursing home staff is often reviewed as antag- onistic, thus cooperation may be less than ideal. In order to keep costs down - which administrators must do if they are to be able to afford accepting medicaid patients - staff may be poorly paid or understaffed 'and ill -trained in working with the elderly. Legal Rights to Services - Several questions were also raised in regard to the legal rights of the elderly. They may not be aware of their rights in guardianships and conservatorships, or their options in nursing home placement. They may also be con- fused as to bureaucratic procedures associated with assistance programs resulting in benefits being terminated to their detriment. Elderly individuals often times have other difficulties in locat- ing and securing the services they need. Although two sources exist for legal assistance (Hawkeye Legal Aid and Heritage Agency on Aging Legal Assistance Programs) these were not felt to be adequate. Heri- tage cannot do extensive investigation nor can they handle a crimi- nal prosecution. The sub -committee felt that there was an absence of legal remedies for many of the abuse, neglect and exploitation problems of the elderly. Data Collection - In discussions with personnel of agencies serving the elderly, it was difficult to document cases of abuse, neglect and exploitation, partially because the victim is reluctant to disclose such instances. Yet there is general agreement that there is a serious problem in this area. More extensive data col- lection is needed if specific problems are to be pinpointed, and action taken to alleviate them. AGENCY J.C. Department '_of Social Services SERVICES PROVIDED FINANCED BY DSS then Title XX after 90 days Iowa City, United Way, Heritage,Space from County 0 17. SERVICF PLUS H OF CLIENTS Protective Services Resolve abuse, neglect complaints. Clients: 28 this past year, 700 hours service. Homemaker Services 147 households 17.1% over 60. 2,000 clients, all over 65. Outreach, advocacy with other agencies, Friendly Visiting ect. Chore services. Federal funding Outreach services Winterization (no ques- tionnaire returned) - Federal, State Legal information and referral; legal services; 475 clients, all elderly I $ R Federal Should serve low-income elderly with legal services; 5% of 500 clients over 60 (25) County, State Outpatient and resi- dential services to alcoholics; about 30 clients over 60 or 10% of total number. • � • ' 18. AGENCY FINANCED BY SERVICE PLUS A OF CLIENTS Mark IV United Way Advocacy. Clients: about 14 over 60. NOTE: State No Funding State Emergency services. Clients: about 14 over age of 60. Friendly visiting/ telephone reassurance (service information). About 60 clients. Informal counseling. 50% of 70 clients. (35) *Receive complaints concerning nursing homes and report to the State Public Health Department. *Do yearly or bi-annual check-ups of all patie * These services per- formed by both the D.S. S., Care Review Team and the Care Re- view Committee. Licensure and inspectior of facilities, investi- gation of complaints against care facilities. Other groups serving elderly with support services may also play a part - see Family and Individual Services.