A Holistic, Community-Based Approach to Health: Addressing Toxic Stress and Trauma

By Heidi B. Miller, M.D

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Dr. Heidi Miller is a primary care physician and policy advocate who has focused her career on assuring high quality, trauma-informed, equitable access to healthcare for our most vulnerable patients. She trained at Yale University and Harvard Medical School and completed her residency in Internal Medicine at Harvard’s Brigham and Women’s Hospital. She serves as a primary care doctor at Family Care Health Centers, a Federally Qualified Health Center in St. Louis. Dr. Miller is also the Medical Director for the Gateway to Better Health Program, which serves 20,000 uninsured patients via the St. Louis Regional Health Commission, an organization that has also spearheaded the Alive and Well STL initiative to reduce the community-wide impact of toxic stress and trauma.

Dr. Miller consults for the St. Louis Integrated Health Network and the Siteman Cancer Center’s Breast Cancer Partnership. She was appointed by the Missouri Governor to the Oversight Committee for Medicaid, served on the Missouri Medical Home Collaborative Steering Committee that oversaw the state-wide implementation of the Patient-Centered Medical Home model, and has been invited repeatedly to testify to the Missouri House and Senate Committees on health policies. Dr. Miller was recognized by the St. Louis Business Journal as one of its “40 Under 40” honorees.

In addressing health issues, too often we focus on individual behaviors, such as eating unhealthy food or neglecting to take prescribed medication. This can lead us to blame people for their poor health. But many individuals experience toxic stress and trauma that powerfully shape the choices they make. We need a more holistic, community-based approach to health.

In medicine, universal precautions are used as a means to ensure the safety of both our patients and staff. We wear gloves while drawing blood for all patients, regardless of which patients have contagious conditions. Medicine is not alone in this approach—all industries utilize safety measures: hard hats in construction zones and flashers for truck drivers carrying wide payloads. These universal precautions are a good start at protecting the well-being of those we serve and those providing the service, but we need to consider these as just the beginning if we’re going to address toxic stress and trauma in our community.

Physicians traditionally learn to take the human body and break it down into organ systems, tissues, and cells. However, when we only look at a single piece, we lose sight of the larger puzzle—the whole. For example, the customary approach for a patient with diabetes is to test for elevated blood sugar levels and write a prescription for insulin to correct the imbalance. When we merely focus on balancing blood sugar levels, however, we can overlook a much larger medical concern, such as debilitating stress. To support the overall health and well-being of patients, the entirety of a person’s body and experiences must be considered, not just a single symptom or laboratory test.

After enduring a detailed history and physical examination, some patients may seem inattentive when their clinician explains their diagnosis and provides guidance on how to take their medications, what foods to avoid, and what lifestyle changes to make. In these instances, false assumptions could be made about patients simply not caring about their own health. Through a lens of toxic stress and trauma, however, we can appreciate that much more is happening in this moment. Possibly this patient is concerned about finding the means to pay for their medications, worried that with everything else going on in their lives that there is no time to take care of themselves, or scared of what the future may hold.

Too often we see a behavior—the customer that’s yelling at the service representative or the cousin who always drinks—and we assign judgement based on that behavior. When simply focusing on the behavior, one may easily assume that a person is bad or deviant. If we reduce a person to the sum of his or her behaviors, we fail to see the person as a whole and fail to acknowledge the toxic stress or trauma the individual has experienced.

To best serve patients and support our fellow community members, we have to stop thinking, “What’s wrong with you?” and instead ask “What happened to you?” By changing the question, we acknowledge that the behavior of an individual, much like the symptom in a patient, is part of a larger story. If we want to effectively make change in our community, we need to change the question in each and every interaction we have.

Alive and Well STL, an initiative of the St. Louis Regional Health Commission, is working to build this dialogue. Challenge yourself: next time you think, “What’s wrong with you?”, consider instead “What happened to you?” Notice if this changes how you feel about the situation. Notice if your understanding of underlying toxic stress or trauma affects how you respond.

If you want to learn more about how you can get involved in making St. Louis a more supportive place to live, please visit Alive and Well’s website: www.aliveandwellstl.com.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

Pooled Purchasing: Leveraging Economies Of Scale For Efficiency And Impact

By Constance Siu

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Constance Siu is Master of Social Work candidate at the Brown School of Social Work at Washington University in St. Louis concentrating in Social and Economic Development (Domestic). Prior to attending the Brown School in 2015, she lived in Kansas City and worked at a child development center. Constance graduated from Beloit College in Wisconsin with a B.S. in Biochemistry and a minor in Philosophy. Upon graduation, she plans to pursue a career in community development in St. Louis.

Community building organizations, simply put, are having a difficult time sustaining themselves financially. Not only are many unable to support themselves for an extended period of time on reserves alone, but many are operating on a deficit. With fewer funding streams supporting operational costs as many foundations move to a more issue- or place-based approach, there is a need for organizations to start thinking more strategically and collaboratively about the future in order to survive and thrive.

The need to collaborate at an operational level drove the Community Builders Network to look for ways to support their members in this area, giving way to the inception of the Professional Services Support Program. Modeled after a similar program in Cincinnati, Ohio, the Professional Services Support Program borrows the basic value proposition from companies like Costco where members access items and services in a pooled manner allowing for discounted rates.

Sounds simple, right? Well, that’s because it is! However, for such a simple model, it isn’t as widespread in the nonprofit realm as you might think—especially since a model such as this has immense benefits for its participants.

Even for St. Louis, this idea is not a particularly innovative one. The Chesterfield Cooperative has already been practicing this model through their bulk rock salt purchases. Working with Beyond Housing and the Chesterfield Cooperative, the 24:1 Community was able to join the Cooperative, resulting in a 40 percent decrease in rock salt costs. With that success, the same collaborative approach was taken with trash collection as smaller communities got to piggyback off larger trash contracts, which again cut costs drastically.

By working together and pooling together their collective weight, not only are smaller groups able to leverage their newfound economy of scale for cost reduction, but doing so also allows for increased operational efficiency and effectiveness.

A simple example of this is in office supplies and printing. Often overlooked as a significant operational expense, as a $20 stapler may not seem like a big difference compared to a $15 stapler, most organizations currently either order these items online or make emergency trips to regular retail stores, costing organizations precious time and human capital as people are doing things that are not mission-centered. By participating in a pooled purchasing program, not only can organizations have a personal account manager take care of their office supplies and printing, but it can also save them those $5 increments that will add up over time.

Over the last few weeks, as I’ve worked on establishing this program, I’ve realized that the benefits of the Professional Services Support Program are so much more than the cost savings that nonprofits can gain. Arguably more important is that participation in pooled purchasing will increase professionalism, efficiency, and the ability to attract financial support from nontraditional funding streams, such as banks and private foundations.

One area where nontraditional funding streams can be leveraged to support a pooled purchasing program would be in accounting. Instead of trying to fit budgeting into the busy day-to-day schedule of running an organization and relying on basic budgeting knowledge probably gained from either a budget 101 course at some point or from balancing our own checkbooks, nonprofits can take advantage of professional accounting services. Not only does this add a sense of professionalism and credibility to their finances, but it also introduces another layer of control as another set of eyes are added to the mix. With a more transparent and professionally managed budget, potential funders will be able to see that organizations they are supporting have more fiscal controls and understand where each dollar is going and how effective each dollar is in terms of mission fulfillment. This makes these organizations safer and more trustworthy investments.

All in all, by collaborating and purchasing services and goods in a pooled manner, organizations can increase their transparency to funders and gain a better understanding of their operational costs, allowing for more funds and time to be spent on mission-fulfilling activities.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

All Low- and Moderate-Income Areas Are Not Created Equal

By Mike Eggleston

This article was originally published in the Federal Reserve Bank of St. Louis’s quarterly newsletter, Bridges.

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Mike is a Senior Community Development Specialist with the Federal Reserve Bank of St. Louis. In this role, he provides financial institutions, community based organizations and government entities tools to effectively address community development issues affecting economically vulnerable individuals and communities. Mike serves on the Board of Directors at the Incarnate Word Foundation.

There are stark disparities in consumer credit in low- and-moderate-income (LMI) neighborhoods across United States metropolitan areas (MSAs), and their full impact on residents’ access to opportunity is not currently accounted for under the Community Reinvestment Act (CRA). Consider George, who lives in Montgomery, Alabama, and Francine, who lives in Madison, Wisconsin. Both live in an LMI neighborhood, where the median income is 80 percent of the average median income in the metro area or state. Each is looking to buy a car, to reduce their commute time to work and to allow them more child care options for their young children.

Like many in his neighborhood, George has poor credit. As a result, he is not able to secure financing from a financial institution to buy a car. Francine, however, is among the vast majority of people in her neighborhood who have good credit—so she has no trouble securing a car loan from a bank.

This story plays out among MSAs across the country in over 200 areas where data is available. Boulder, Colorado is on one end of the spectrum, where 35.9 percent of the population in LMI neighborhoods is credit constrained: that is, they have poor, fair, or no credit history. On the other end in Memphis, Tennessee, nearly eight out of every 10 people in LMI neighborhoods are credit constrained. This disparity has big implications for both neighborhood residents and the regulated financial institutions that serve them, thanks to the obligations these institutions face under the Community Reinvestment Act (CRA).

Before going further, it’s worth noting some additional observations. LMI neighborhoods where residents have better credit tend to have a larger percentage of white occupants. They are usually located in the East, West, and parts of the upper Midwest, and tend to have relatively low poverty rates. LMI neighborhoods where residents with poor credit predominate tend to have a larger share of African-American occupants. They are usually located in the South and tend to have relatively high poverty rates. In fact, among the ten MSAs where people living in LMI neighborhoods have the poorest credit, the average poverty rate is 68 percent higher than the average poverty rate of the ten MSAs where people living in LMI neighborhoods have the best credit. Jackson, Mississippi, Shreveport, Louisiana, and Montgomery, Alabama all fall into this category.

In sum, the credit profiles of people living in LMI neighborhoods across the country vary significantly. Why should that matter? There are at least two groups for whom this matters a great deal.

A good credit profile can be the make-or-break detail that determines someone’s ability to get a mortgage, car loan, or student loan. It can also be a factor in whether someone can rent an apartment, in how much insurance costs, and in securing employment. In short, good credit can signal whether someone’s financial situation is on the right track. This can be especially powerful for someone living in an LMI neighborhood, where opportunities to improve life circumstances can be scarce. That’s why many nonprofit organizations throughout the country—sometimes in partnership with bank representatives—work with people to improve their credit profiles. It’s also why some community-based organizations (like Justine Petersen, headquartered in St. Louis) view credit as an asset.

Depending on their size, regulated financial institutions are required to comply with the CRA by meeting certain thresholds for investments, loans, and service in LMI neighborhoods. Currently, the credit profile of a bank’s assessment area—which may include an entire MSA or just part of it—is not weighed as a factor when determining whether a bank is meeting CRA obligations. But maybe it should be. As the data illustrates, a bank operating in Madison, Wisconsin will have a much easier time finding qualified borrowers in LMI neighborhoods than a bank in Memphis, Tennessee. A bank operating in both metro areas must work twice as hard to find qualified borrowers in Memphis.

This raises important questions about the appropriate role of the CRA in promoting fair and impartial access to credit in underserved communities. Should extra weight be given to loans and investments made in LMI areas where more people are credit constrained? How can the CRA’s service test better encourage credit building in LMI areas where more people are credit constrained? Can other measures, such as the poverty rate, complement area median income to select CRA target populations?

For the first time, consumer credit data for LMI areas in 200-plus MSAs is publicly available via the Consumer Credit Explorer, thanks to Equifax and the Federal Reserve banks of Minneapolis, New York and Philadelphia. Using this data, researchers will soon be able to better understand why LMI neighborhoods in one MSA have drastically different credit profiles from LMI neighborhoods in other MSAs. Until that is sorted out, LMI neighborhood residents like Francine in MSAs such as Madison, Boulder, and San Jose will have a much better shot at accessing credit—and opportunity—than LMI neighborhood residents like George in MSAs such as Montgomery, Memphis and Jackson.

Data: FRBNY Consumer Credit Panel/Equifax Data (12/1/2015), tabulated by the Federal Reserve Banks of Philadelphia and Minneapolis and accessed via the Consumer Credit Explorer.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

Immigrants Can Help to Revitalize Inner Cities in the 21st Century

By Cyril D. Loum

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Cyril D. Loum is the Executive Director of Caring Ministries, Inc. (CMI). He has been actively involved in working with the development of the St. Louis community since the beginning of 2011, after he graduated with a bachelor’s degree in Political Science from the University of Missouri-St. Louis. In 2011, he served as a Federal Intern for the First District of St. Louis while attaining his second bachelor’s in Communication. In 2014, Cyril proceeded to earn a Master of Arts in Legal Studies and became a certified paralegal.

In recent years, many immigrants and refugees have been moving to the United States to be part of the American Dream. The American Dream that “every U.S. citizen should have an equal opportunity to achieve success and prosperity through hard work, determination, and initiative” has changed our communities, especially our inner cities. Our inner cities now have large concentrations of immigrants who contribute to the success of many of the most economically vibrant U.S. cities. In response to this trend, Caring Ministries, Inc. (CMI) was established to reinforce the positive trends of immigrant influxes to revamp inner-city communities.

The process of establishing strong communities with immigrants and Americans starts with building strong relationships with various neighborhood leaders. Immigrants need to have conversations about the safety of neighborhoods and school systems. Other issues that the immigrant population faces are the necessary demands from extended family members living abroad and the fragmented family unit.

To build vibrant immigrant communities, you need a holistic approach that addresses social, spiritual, physical and economic needs. For immigrants, the social aspects include tight-knit neighborhood associations. Immigrants see these neighborhoods as a kind of extended family, which they can depend on for assistance in times of need. This social aspect helps the families relate to their community, while giving them the opportunity to build new relationships. Often coming out of an oral tradition, immigrants understand intuitively the idea that “it takes a village to raise a child.”

One of the ways these bonds are established is through shared faith. Regardless of origin country, immigrants entering the U.S. usually identify themselves as spiritual people. When dealing with the immigrant population, one difference from Americans is that they are open to talking about their faith. As we work on these communities, we have noticed that the sentimental feelings of spirituality within the immigrant population and community developers can build a sense of trust.

Next, when dealing with the physical nature of neighborhoods, we need to build communities where shopping centers and bus lines are in close in proximity to homes. This is important because most immigrants are accustomed to having local community grocery stores, schools, places of worship, parks, and other community amenities close to their homes. Many immigrants moving to the U.S. were already homeowners. The housing culture of immigrants is based on the idea that homeownership enables families to pass on tangible resources to the next generation. Immigrants are not commonly accustomed to apartments. Perhaps this is the cause of minor ghettos in St. Louis. Nevertheless, homeownership is difficult for immigrants in the United States, because they use a different method of homeownership from their country of origin. In the U.S., we use financing through banking institutions, and the approval of financing is based on credit scores. In their country of origin, immigrants often used the sole capital of an individual to either build or purchase their homes. However, when given the opportunity in the U.S., immigrants want to become homeowners.

Economically, immigrants want to live in communities where the job market is strong and homes are inexpensive. These two specifics give immigrants the opportunity to achieve the American Dream by using their willingness to work hard to achieve the necessary things that make them comfortable. Jobs are very important to this population. They are willing to put in the time and effort once their financial needs are met. Immigrants are generally frugal in their financial lifestyle. In fact, this population believes in saving and helping people in need, who then can turn around and assist them some day. Immigrants might be seen as a demographic that is struggling financially, but once acquainted with the financial system, they become some of the most financially secure people in our society. This is why some of the most vibrant inner cities are highly populated by immigrants.

I encourage individuals working in community development to think about immigrants as a valuable resource for building vibrant communities.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

Crystallizing A Multi-Faceted Approach To Community Development

By Sylvester Brown, Jr.

This column was originally published on the author’s blog.

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Sylvester Brown, Jr. is a writer, community activist and the executive director of the Sweet Potato Project, a St. Louis-based program dedicated to teaching at-risk youth entrepreneurial skills through agriculture and product development. 

On Friday, September 9th, I was awarded the 2016 MLK Legacy Award for “Outstanding Service in the Community.” About four other individuals were also honored during Beloved Streets of America‘s first annual MLK Legacy Dinner. It’s always nice to be recognized for trying to do something positive, but for me, the true reward was the event itself and the realization that I am a part of a game-changing group with unrecognized potential.

I have to be honest: I’ve been besieged with doubt about the Sweet Potato Project (SPP). Our mission is basic but powerful. For the past five years, we’ve been working with at-risk teens to show them how to become self-sufficient and make money in their own neighborhoods. Students plant produce on vacant lots, and after harvesting they turn produce into products.

Simple, right?

Our bigger mission is to help low-income people gain access to vacant lots, grow food and develop ways to sell through farmer’s markets, direct delivery or by selling food-based products like our sweet potato cookies. If hundreds of poor folk are growing and thousands are buying from local urban farmers, we have a shot at creating a real economic engine in North St. Louis.

Powerful, right?

Well, not so much—at least not for SPP. Our funding has decreased significantly within the past two years. Our students made it through the summer, with the help of a few individuals who hosted fundraisers for us. However, it’s become painfully obvious that we can’t continue operating with a tiny staff and limited funds on a shoestring budget.

So that was the sort of funk I was in when I arrived at the MLK Legacy Dinner. The real reward that evening came in the form of inspiration through the activities of other awardees and some extraordinary ordinary people I know who are also striving to enact social and economic change in the black community.

My reward that night was the crystallization of a major multi-faceted approach to community development. After accepting my award, I asked the audience to dream with me. Imagine a vibrant and refurbished MLK (Beloved Streets of America), I said, where people own homes (Better Family Life); with dozens of black-owned storefronts (the Center for the Acceleration of African-American Business) in an area like the University City Loop where art and culture is part of the neighborhood’s fabric (Portfolio Gallery and Education Center); where economically empowered landowners grow food that supplies the entire region (the Sweet Potato Project).

I was also reminded of the five or so food-related entities already working in the Greater Ville area on or near MLK Boulevard. St. Louis University was recently awarded a USDA grant to help fund these agencies. SPP is a part of that collaborative. Project plans include a food market, industrial kitchen to develop “value-added” food products and more urban farms in the area. If more funds were directed to these entities and organizations recognized at the Beloved Streets event, we’d have a huge swath of MLK in North St. Louis dedicated to empowering low-income youth and adults, job creation, home and land ownership and small business growth—which can all lead to neighborhood safety and sustainability.

There are basically two obstacles that impede this grand vision. First, as Malik Ahmed noted after he and Deborah received their awards, black organizations must collaborate, strategize and go after funding as a collective. The second challenge is the lack of vision among politicians, city planners, nonprofit funders and corporations. St. Louis leaders seem to have one model for community development: “Let’s give these rich guys and powerful entities millions upon millions in state, local and federal tax breaks and public money and, hopefully, their success will trickle down to people in poor communities.”

Politicians have exuberantly signed off on developments such as the $16 million failed attempt to keep the Rams in St. Louis along with the billion dollars to build them a new football stadium. Then there’s Paul McKee’s Northside Regeneration project, which will receive up to $390 million in tax-increment financing. The estimated $2.1 billion Cortex District and the $1.75 billion National Geospatial-Intelligence Agency’s headquarters are all buoyed by tax incentives, deferred taxes and public money.

This is all well and good, I suppose, but if we’re leveraging the city’s tax base for the rich, implementing gentrification in North St. Louis and short-changing public schools dependent on tax dollars, shouldn’t a fraction of the public money go to sacrificing, struggling black organizations that are dedicated to empowering residents, educating young people and building businesses within the most disadvantaged and ignored areas of our city?

When it comes to sharing public money and investing in the black community, we’re up against a decades-old, stubborn, segregationist mindset in St. Louis. Still, I have hope. Can politicians—particularly black and progressive politicians—simply call for a time-out on doling out dollars to the rich and powerful? Can’t they insist on a little quid-pro-quo for their loyalty and demand that elitist city planners include black organizations in the mix? If those of us dedicated to enacting real, people-centered change worked together, perhaps we can help introduce a new template for development that actually empowers people to do-for-self economically.

These things and more are the fruits of an award that emphasized the potential rewards right here, today, within our midst.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

St. Louis Needs More Cross-Community Conversation

By Kevin McKinney

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Kevin McKinney is the Executive Director of the St. Louis Association of Community Organizations (SLACO). He has eighteen years of experience in housing and urban development. Prior to joining SLACO, Kevin spent nine years as Mayor and a member of the Board of Aldermen in Jonesborough, Tennessee and three years serving in leadership roles for the Shaw Neighborhood Improvement Association in St. Louis. Since 2003, Kevin has been the owner of Housing 202 Ltd., serving as a consultant for faith-based and non-profit organizations in Missouri and nationwide. He has been involved with the development of eight senior housing facilities and two housing developments for persons with disabilities. Kevin has been named one of the St. Louis Business Journal’s “40 Under 40,” won the Centurion Award for Outstanding Contribution in Human Rights, and completed the FOCUS St. Louis Impact St. Louis Leadership Program. He and his wife Kimberly are residents of the Shaw neighborhood. Kevin is a board member of the South City YMCA and the Friends of Tower Grove Park and serves as the 1st Vice President of the Garden District Commission.

Could the contention and turmoil that surfaced as a result of Ferguson locally and in cities like Cincinnati and Dallas nationally result in opportunities to bridge the racial divide? In order to move forward and build a stronger community, I believe it is imperative that we learn to appreciate each other regardless of zip code.

Many have addressed the problems we have hearing and understanding each other across the St. Louis region’s many boundaries. St. Louis is highly segregated along race lines and fragmented in its sense of community identity. These barriers limit our access to common frameworks that might otherwise help us relate to each other and talk across community borders.

I believe a new program from the St. Louis Association of Community Organizations (SLACO), Neighborhoods United for Change, can help bridge these divides. SLACO has partnered with CREA (the Civil Rights Enforcement Agency of the City of St. Louis) and the City’s Neighborhood Stabilization Team to build a robust platform for discussing racial and social equity. Doug Bram, winner of the “250 Ways to Improve Your Neighborhood” contest (as voted by participants in the 2014 SLACO Regional Neighborhood Conference) originated this idea before it was advanced by then-Executive Director of SLACO, Nancy Thompson. SLACO has a history of inclusiveness—we specialize in providing opportunities for neighborhoods to learn from and network with each other to create a desirable urban environment. SLACO’s 30 member neighborhoods represent over 33 percent of the City’s population.

Neighborhoods United for Change will allow people to interact across invisible community lines. Participants from one SLACO community will tour another St. Louis neighborhood to gain insight about its strengths, successes, and challenges. Residents from one part of the city will have a chance to see how fellow St. Louisans from other neighborhoods live. The program provides a platform for members of our community to meet one another, visit the places they call home, learn about their everyday experiences firsthand, and grow to understand each other more completely. It creates an opportunity for people to connect based on similarities, while reinforcing mutual respect for differences.

The program’s kickoff events, which start this month, will pair two neighborhoods for tours, lunch, and conversation. SLACO member neighborhoods Princeton Heights, Forest Park Southeast, West End, Tower Grove East, Holly Hills, Lewis Place/Visitation Park, Fairground, West Pine/Laclede, Tower Grove Heights, and Shaw will be participating, along with non-SLACO member neighborhoods Bevo Mill, Jeff-Vander-Lou, College Hill, and Baden. Pairs of neighborhoods will plan and execute the events together with support from SLACO, CREA, and the Neighborhood Stabilization Team.

After the kickoff, SLACO, facilitators, and partners will support activities that broaden and build on the relationships developed by the paired neighborhoods. We aim to enrich recurring activities with a new element: the chance to see one’s own area through someone else’s eyes.

We need more programs that encourage this type of meaningful connection and tap into shared growth potential. At the end of the day, no matter where we live, we’re not that different from each other. We all want similar things for our community: the option to live in a welcoming, safe neighborhood; access to good jobs; high-quality schools for our children; and the chance to pursue opportunities and increase the standard of living for our families. Neighborhoods United for Change will encourage participants to form friendships along common lines like these. We can all help build a better St. Louis by cultivating more cross-community conversation.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

The REAL Rental Housing Issue

By Alan Mallach

This column was originally published in the National Housing Institute’s Rooflines blog.

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Alan Mallach is a senior fellow at the Center for Community Progress in Washington, D.C. A city planner, advocate and writer, he is nationally known for his work on housing, economic development, and urban revitalization, and has worked with local governments and community organizations across the country to develop creative policies and strategies to rebuild their cities and neighborhoods. A former director of housing and economic development in Trenton, New Jersey, he currently teaches in the graduate city planning program at Pratt Institute in New York City. He has spoken on housing and urban issues in the United States, Europe, Israel, and Japan, and was a visiting scholar at the University of Nevada Las Vegas for the 2010-2011 academic year. His recent books include A Decent Home: Planning, Building and Preserving Affordable Housing and Bringing Buildings Back: From Vacant Properties to Community Assets, which has become a resource for thousands of planners, lawyers, public officials, and community leaders dealing with problem property and revitalization issues. He is a member of the College of Fellows of the American Institute of Certified Planners, and holds a B.A. degree from Yale University.

We know a few things about the majority of very low-income renters: they live in private market housing, not tax credit projects or public housing. They receive no housing subsidies. They are paying far more than they can afford for what is too often substandard housing in distressed neighborhoods.

These statistics are well known, but we don’t think about them as much as we should, and often lose track of the human toll behind them.

Evicted by Harvard scholar Matthew Desmond tells that story. It’s a twofold issue: the most fundamental problem is that the economics of what poor people live on—from public assistance or low-wage jobs—are inadequate to afford what it costs to create or provide minimally decent housing. The 25th percentile rent in the United States—the low-end median rent, where one-fourth of the units rent for less and three-fourths rent for more—is $670 per month, which requires an income of $26,800 to afford. Even the most self-sacrificing landlord can’t pay off a mortgage, pay taxes and maintain a rental unit in decent shape for what a poor family can consistently afford to pay.

The second problem is that our political system has failed to address this issue in a meaningful way. Instead, we have a sort of lottery system in which only a lucky few get housing vouchers. Poor tenants, whose incomes are both low and highly unpredictable from one month to the next, live like refugees in a revolving door of substandard housing, dangerous neighborhoods, rent arrears, doubling up, evictions, and forced moves almost on a yearly basis.

Millions of people are evicted each year, and millions more move involuntarily without waiting for a formal eviction proceeding. Without a stable place to call home, these families live in a constant state of social and economic instability, with their children moving from school to school. This perpetuates the multigenerational poverty that characterizes many inner city neighborhoods and frustrates efforts by CDCs and others to build strong, cohesive neighborhood organizations and stable neighborhoods.

In response, the community development field tends to focus on building tax credit housing. But a recent HUD study has raised tough questions about what tax credit housing means in this context. Although tax credit rents are set at what a tenant at 50 percent of the Area Median Income (AMI) can afford, most tenants have much lower incomes: 45 percent have incomes below 30 percent of AMI, and 19 percent between 30 and 40. Unlike public housing rents, LIHTC rents are not adjusted to family incomes. This means two things: first, many LIHTC tenants make ends meet by using a Section 8 Voucher to make living affordable. Although the HUD data is hard to interpret, at least 36 percent of all LIHTC tenants appear to have a voucher or some other form of rental assistance. An educated guess is that at least one out of every three vouchers in circulation is being used in a tax credit project.

Second, of LIHTC tenants who do not have a voucher, more than 60 percent are paying over 30 percent of their gross income in rent and suffering from precisely the cost burden that affordable housing is supposed to prevent. This probably represents a better option for most than private market housing—the quality of housing is likely to be higher, and in very high-cost areas, tenants’ cost burden may still be less than it would be on the private market. The point, though, is that LIHTC housing is not a solution. What can be done?

This should be the focus of national advocacy efforts. The National Low Income Housing Coalition has done great work, but it is not enough. Rather than advocating for more vouchers, we should look more closely at how to best fill the gap between what poor tenants can afford and what it costs for the private market to provide decent housing—and build a broad coalition around it.

How could we best meet these needs? Over 40 years ago, President Nixon proposed a guaranteed annual income for every American family. Would putting more money into people’s pockets help them find decent housing with fewer market distortions than the Section 8 program? Alternatively, could vouchers become more property- (not project-) based, with a competitive model in which landlords could compete for vouchers based on price and quality? I’m sure there are other models worth examining as well.

In the meantime, this is a critical issue for any organization trying to build stronger neighborhoods. Tenants in private market housing, most of them low- or very low-income, make up half or more of the residents of most lower urban neighborhoods. We must look at how the community development field can better support tenants in private market housing. We have a decent although patchy network of organizations to help homeowners keep their homes, but nothing I’m aware of to help renters keep their homes. Change is long overdue.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

Modern-Day Redlining in Communities of Color

By Elisabeth Risch and Jackie Hutchinson

This column was originally published by the St. Louis Post-Dispatch on August 18th, 2016. To view the original article, click here.

Elisabeth Risch

Elisabeth Risch

Elisabeth Risch is the Director of Research and Education at the Metropolitan St. Louis Equal Housing and Opportunity Council. She is the Co-Chair of the St. Louis Equal Housing and Community Reinvestment Alliance (SLEHCRA), where she works directly with banks to increase investment and services to low-income communities and communities of color. She holds a Bachelor’s Degree in Sociology from Calvin College and Master’s Degree in Social Work from Washington University in St. Louis. She is a board member of the National Community Reinvestment Coalition.

Jacqueline Hutchinson is VP of Operations for People’s Community Action Corporation in St. Louis. She is actively involved in policy and advocacy issues that affect low-income consumers in the St. Louis region. Jackie is Co-Chair of SLEHCRA, where she works to increase investment in LMI communities; serves as board chair for Missouri Consumers Council; and is a member of the Unbanked Task Force. She has a Master’s Degree in Policy Analysis from Southern Illinois University and a Bachelor’s Degree in Business from Washington University in St. Louis.

Jackie Hutchinson

Jackie Hutchinson

SLEHCRA is a coalition of non-profit and community based organizations working to increase investment in low- and moderate-income communities, regardless of race, and in minority communities, regardless of income. SLEHCRA ensures that banks are meeting their obligations under the Community Reinvestment Act and fair lending laws.

In St. Louis, it is harder to get a loan in communities of color. That’s what a new report by the National Community Reinvestment Coalition (NCRC) found. The report looks at mortgage lending data in the St. Louis region over the last few years and finds extensive disparities in communities of color.

The data and the maps in this report help to visualize what many of us already know and experience. Lending is concentrated in white areas and scarce in black neighborhoods. Certain neighborhoods have poor access to banking resources, and many households are unbanked or underbanked, particularly African-American households. In the entire St. Louis metropolitan area, median family income of the neighborhood is the best predictor of home loan activity. However, in the City of St. Louis, the racial composition of a neighborhood is also a strong predictor of mortgage activity. In hyper-segregated neighborhoods in which the population is over 75 percent black, less than one percent of homes received a home purchase loan in the 2012-2014 period. Most problematic: the lack of lending in high minority areas is not fully explained by income differences. Credit is still available to white neighborhoods with the same income level.

Isolation from financial services further concentrates poverty and perpetuates the cycle of disinvestment seen in black neighborhoods all around us. If our city hopes to rebuild and revitalize long-neglected neighborhoods, we must break this pattern that hurts individual homeowners, families and our entire region. Housing values have plummeted in those neighborhoods, and there are few comparable sales in the area to fuel the market. To find a cash buyer, families in black neighborhoods must often sell their homes for thousands less than if their neighborhood had equal access to credit. Homes sit vacant and fall into further disrepair. For many families, buying a home builds equity and increases wealth, plus will often cost less in the monthly mortgage than what they pay for rent in these same neighborhoods. Lack of credit access prevents families from building wealth in home equity and savings.

Since 2009, the St. Louis Equal Housing and Community Reinvestment Alliance (SLEHCRA) has worked with banks in our region to improve access to banking and improvements have been made. During this time, banks have opened new branches, created new products, and increased outreach and investment in communities of color. More banks are participating in collaborative efforts to address unbanked and underbanked households, as well as financial education programs.

But this report shows that we have a long way to go. Decades of discriminatory practices will take many years to reverse. We call for more banks to develop quality products—including innovative loan products and checking and savings accounts—and to actively seek opportunities to develop partnerships that create investment in communities of color. New partnerships can also lead to more bank branches opening in banking deserts. We ask banks to increase support to financial empowerment centers and nonprofits providing financial education. We ask banks to discontinue the practice of providing credit to those payday loan businesses whose interest rates are predatory debt traps that strip wealth from communities, especially communities of color.

We urge community members to join with SLEHCRA in our efforts assure equity in financial services in all communities; to support strong payday lending reforms proposed on a local, state and national level; and to support efforts to strengthen and update the Community Reinvestment Act to better reflect today’s financial system.

Finally, we echo the calls in the Ferguson Commission’s report to Build Equity through Enhanced Access to Banking and to Promote Asset Building. Ultimately, we must work collaboratively—as community members, organizations, banks, regulators, and local governments—to ensure that all neighborhoods, including black neighborhoods, have equal access to credit and the opportunity to build stable and healthy communities.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

5 Reasons Why CDCs Should Communicate the Health Impact of Their Work

This column was originally published by the National Alliance of Community Economic Development Associations (NACEDA) on June 5th, 2015. To view the original article, click here.

By Kavya Sekar


Kavya Sekar is Master of Public Policy Candidate at Duke University Sanford School of Public Policy. She recently served as the Mel King Institute (MKI) Program Coordinator with the Massachusetts Association of Community Development Corporations, coordinating trainings, forums and programs to boost skills, knowledge and leadership of community development professionals in Massachusetts. She is a 2013 graduate of UNC Chapel Hill with a double major in Biology and Anthropology. During college, she was extensively involved in social justice initiatives around homelessness and poverty as well as public health research on nutritional issues in the United States and India. Before working at MKI, Kavya served as a Fulbright-Nehru research student fellow in India, studying the health behavior and access of Type II diabetes patients among low-income and slum communities in Mumbai. In her recent role with the Mel King Institute, Kavya used her public health research background to boost community development and public health partnerships in Massachusetts by coordinating a training series, convening health and community development leaders, conducting research, and writing editorial content on health and community development.

When I started my role at MACDC back in September, one of the first events I attended was our Innovation Forum “How Can We Better Leverage the Health Impact of Community Development?” With my background in public health, I was excited to connect the dots between my previous work and my current role in community development. I decided to move away from public health, in part, to learn more about economic and structural inequalities, so it was important to be reminded that “a person’s zip code has a greater impact on a person’s health than his or her genetic code.”

With my background and interest in health, I am helping develop training programs on community development and health for The Mel King Institute. As a part of this process, I explored CDC websites to look for health related programs. What I found was somewhat disappointing: while CDCs are doing work that helps improve the health of their communities, very few are talking about it. Housing, economic development and community building all have a positive health impact and here’s why we should tell the world:

  • It tells a compelling story: In a Rooflines blog post, Jonathan Reckford of Habitat for Humanity writes about how moving into a safe mold-free home helped stop a young boy’s asthmatic seizures. Stories like these can help the general public understand the real importance and urgency of providing safe and affordable housing to save lives.

  • There is plenty of evidence to support your claims: In the recent “The Health Impact of the Community Investment Tax Credit” report, Health Resource in Action, MAPC and MADPH use evidence from the latest public health research to show how CDC activities are linked to better health outcomes. Using the conclusions from this report, community developers can confidently speak about the health impact of their work and reference research to support their claims.

  • It could lead to new partners: Under a provision of the Affordable Care Act, nonprofit hospitals are now required to conduct Community Health Needs Assessments that “take into account input from persons who represent the broad interests of the community served by the hospital…including those with special knowledge of or expertise in public health, and is made widely available to the public.” Based on their findings, hospitals must adopt an implementation strategy to meet community public health needs at least once every three years. As community organizations, CDCs can play a major role in helping hospitals understand community needs, develop plans to meet those needs and implement solutions. Openly communicating your organization’s commitment to and impact on health can help hospitals see your organization as a potential partner.

  • It could lead to new resources: As health-related funding agencies and organizations have become more aware of the social determinants of health, there is movement towards supporting healthy neighborhoods. For instance, Madison Park Community Development Corporation has a grant from the Boston Public Health Commission for programs to reduce youth violence. CDCs all over the state receive donations from hospitals and healthcare centers. Communicating the health impact of your work can help attract these sources of funding and, therefore, leverage your work to meet the mission of health organizations.

  • It helps us move beyond our silos: Ultimately community development and health organizations have a common goal: to promote the overall well-being of people and communities. Poor health leads to poverty and poverty leads to poor health. By acknowledging this linkage and working together, we can move the needle on addressing the major health and economic inequalities in our society.

CDCs are already improving people’s health on a daily basis. By articulating the health impact of your organization, you can offer a more compelling story about your organization, access more resources, and ultimately have a bigger impact on the communities and families you serve.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

Augmented Reality and the Future of Community Development

By Gary Newcomer

08.03.16 Gary Newcomer.jpg

Gary Newcomer is the newest addition to the Community Builders Network of Metro St. Louis (CBN). As a native of South St. Louis City, Gary has always had a passion for exploring and strengthening the rich fabric of neighborhoods in the St. Louis region. He graduated from Boston College and later received his Masters from Saint Louis University in Urban Planning and Development with a research focus on alleys in St. Louis City. Before starting at CBN, Gary worked on historic redevelopment projects in St. Louis and Davenport, Iowa and specialized in the historic tax credit program. His background in urban planning and historic real estate development have contributed to his approach to community development and made him a strong believer in place-based solutions for promoting vibrant and inclusive neighborhoods.

I spent Friday night playing Pokémon GO. I admit it. In fact, I downloaded the iPhone app on the first day it hit the market. But before you relegate the game or my op-ed to Millennial hogwash, consider that Pokémon GO has strong implications for the future of community development.

I intend to convert the nonbelievers, but first let me take a moment to initiate those unfamiliar with the game.

Pokémon GO works by scattering Pokémon monsters, Pokéstops, and Gyms across a street map not too different from what you find on Google. By commanding your smart phone’s GPS and pedometer, the game requires users to get out of the house and explore the neighborhood. Pokémon are all over (I caught a Rattata on a man’s lap outside of Cafe Mochi), but the Pokéstops and Gyms are actual landmarks. These range from churches to statues to that Chinese restaurant you’ve been meaning to try. My roommate and I took to the streets of Tower Grove South to test it out. We meandered up South Grand, holding our iPhones at arm’s length and attracting dozens of stares. What we discovered immediately, besides hordes of digital Pokémon bouncing across the sidewalk, was how much the game encourages social interactions.

Neighborhoods with a high density of businesses and landmarks have more Pokéstops, Gyms, and wild Pokémon. Essentially, St. Louis’s most walkable areas like South Grand and the Delmar Loop are packed full of Pokémon and, inevitably, young people playing Pokémon GO. Pokémon want to be around people, and the game ultimately rewards vibrant, community-oriented spaces.

Gyms are community gathering spots in the most organic sense. Pokémon GO manages to identify a community’s assets and amenities like a team of social workers. These locations are not just schools or parks or popular restaurants. On my block, the two gyms are a gay bar specializing in amateur drag and a Vietnamese restaurant. Both buildings are fairly nondescript and rarely attract the attention of those driving past. However, I can attest to the tightly-knit communities that frequent both.

The game is a success because it harnesses an aspect of community that too often gets neglected: a sense of place. Pokémon GO elevates the ordinary spaces where we conduct our lives by signaling an added importance. Users do not just catch imaginary Pokémon and battle in virtual Gyms, but explore the places they pass every day and even check out new neighborhoods altogether.

The joy of playing Pokémon GO is sharing an array of community spaces and, just as importantly, a common language to describe them and our experiences. My roommate and I had a reason to pause at Franz Park. We had a reason to walk around the block after dinner and, ultimately, bump into a few neighbors. We had a reason to engage with strangers and visit the Grey Fox Pub. I may have lost my Pokémon battle, but stayed for the cabaret. I have heard these stories countless times: people discovering local businesses through the game or noticing a historical marker or speaking to a neighbor for the first time.

Pokémon GO is an example of the role technology can play in community development, an aspect of 21st century engagement too often cast aside in favor of hands-on, boots-on-the-ground, by-the-sweat-of-our-brows community development. I know it is easy to scoff at a game where twenty-somethings catch virtual Japanese creatures. Naysayers are right to call it what it is: a fad. However, the future of augmented reality is not.

How can we bridge the virtual and physical world to better our communities? This question will define the field in the next decade. Imagine pointing a phone at a vacant lot and seeing a 3D architectural rendering rising from the street. Consider virtual markers identifying places in community history. Envision rewards for young people to vote, attend public meetings, or contact their local representatives. If these technologies seem farfetched or unattainable, talk to the child catching a Pikachu in Tower Grove Park. Pokémon GO showcases all of these tools with incredible success. We are cheating ourselves if we do not engage with them for the purpose of community development.

Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.