Dominique Joyal, MD

• Interventional Cardiology Fellow
• Cardiology Division
• Loyola University Medical Center
• Maywood, Illinois

This evidence suggests that the increases in average incomes are legitimate and not simply driven by the attrition of lower-income households medications post mi generic seroquel 300 mg visa. For example medicine tour 300mg seroquel amex, in December 2013 medicine 5658 seroquel 200mg without prescription, 62 of the 1 treatment for plantar fasciitis best 200mg seroquel,232 households did not appear to receive assistance medications used to treat fibromyalgia effective 200mg seroquel. I assume that any year-to-year fluctuation in this population is random and not driven by household characteristics that would be endogenous with earnings potential medicine ball cheap seroquel 50mg. Department of Health and Human Services, which are updated every year and adjusted for household size. In two sites, the poverty rate declined substantially, by 15 percentage points in San Francisco and 11 percentage points in Chicago. In Boston, New Orleans, and Chicago, the poverty rate fluctuated during the period of analysis and does not show a clear trend. In December 2016, the poverty rate was down in Boston and Seattle, by less than 2 percentage points, and was up in New Orleans, by less than 2 percentage points. In all five sites, the poverty rate remained more than 60 percent in December 2016. During the same time period, the poverty rate among the comparison group declined from 69 to 67 percent. Several mechanisms exist by which Choice could lead to increased income for assisted housing residents. At the very least, these case managers help residents through the relocation process. Some provide more extensive services, such as connecting residents to job training programs or helping them to access other forms of public assistance. As with other analysis in this article, this calculation is limited to individuals who are part of a baseline household that remains assisted in a subsequent quarter. Three sites experienced double-digit growth in the percentage of work-able adults with wage income-San Francisco from 21 to 38 percent, New Orleans from 37 to 50 percent, and Chicago from 25 to 37 percent. Boston and Seattle, the sites with the highest percentage of wage earners at baseline, increased by 6 and 5 percentage points, respectively. During the same time period, the comparison group also experienced an increase in the prevalence of wage income, from 38 to 44 percent. A thorough analysis of the demographic composition in these Choice developments is outside the core focus of this article, but it is important to look at a few key characteristics of the population. As noted previously, I examine wage prevalence with a focus on those who I expect to work for pay-able-bodied adults. Changes in this population could be important drivers of the economic circumstances of Choice residents. Exhibits 17 and 18 show the percentage of individuals from each site that are age 65 or older or have a disability. First, Yesler Terrace in Seattle has a very high proportion of seniors and people with disabilities, and both groups have grown as a proportion of the total population at the site. The senior population has increased in New Orleans and Seattle, in both raw numbers and as a proportion of the total population. Boston, New Orleans, and Seattle have experienced increases in the number of people with disabilities, even as the total number of residents has declined. All five sites have experienced proportional increases in the number of people with disabilities, although by only 2 percentage points in Chicago and 6 percentage points in San Francisco. The comparison group also has a very high, and increasing, proportion of elderly people and people with disabilities. I focus on attrition rates, relocation patterns, and changes to the economic circumstances of residents. Pooled across all five sites, in December 2016, 68 percent of active baseline households lived at least 500 feet from their original locations. It is too early to speculate about the ultimate rate of return at these five sites. With respect to income and earnings, conditions are improving for baseline residents of Choice developments. Household income has increased, wage income has become more prevalent, and poverty rates have declined (except in New Orleans). The rate of improvement varies by site, and further research is needed to understand the drivers of these gains. Furthermore, it is not obvious that the Choice program caused these improving conditions. Further research should apply more advanced statistical techniques to determine whether Choice investments caused these positive changes. Additional research is needed to understand the experience and outcomes of these households. Of course, it will also be important to examine additional cohorts of Choice implementation grantees as they progress through the redevelopment process. Department of Housing and Urban Development, Office of Policy Development and Research, Program Evaluation Division. The Final Report of the National Commission on Severely Distressed Public Housing: A Report to the Congress and the Secretary of Housing and Urban Development. Popkin, Susan, Bruce Katz, Mary Cunningham, Karen Brown, Jeremy Gustafson, and Margery Turner. Cityscape 473 474 Departments Evaluation Tradecraft Evaluation Tradecraft presents short articles about the art of evaluation in housing and urban research. Through this department of Cityscape, the Office of Policy Development and Research presents developments in the art of evaluation that might not be described in detail in published evaluations. Researchers often describe what they did and what their results were, but they might not give readers a step-by-step guide for implementing their methods. This department pulls back the curtain and shows readers exactly how program evaluation is done. If you have an idea for an article of about 3,000 words on a particular evaluation method or an interesting development in the art of evaluation, please send a one-paragraph abstract to marina. Real Estate Analysis as a Tool for Program Evaluation Jaime Bordenave the Communities Group Dennis Stout Econometrica, Inc. Abstract this article describes the use of standard techniques of financial analysis-sources and uses statements and pro forma models-in the evaluation of the U. Sources and uses statements provide a convenient framework for analyzing how a real estate development project is financed. Pro forma models are cashflow estimates of the performance of a real estate project over time under a set of assumptions. Lenders, developers, appraisers, brokers, and others involved in real estate transactions commonly use both tools to determine feasibility, structure financial transactions, establish property valuations, estimate investment returns, analyze risks, and make financial decisions. Analytical Tools We present two common tools used in housing and real estate analysis: (1) the development budget (sources and uses statement) and (2) the long-term operating pro forma. The development budget identifies the amount and sources of financing and how those funds will be deployed to complete the planned development. For the development budget to be in balance, total sources of funds should equal total uses of funds. If necessary project costs (uses) exceed identified sources, a gap exists that needs to be filled for the project to proceed. Uses of funds shows the development budget by line item, including the type and amount of expenditures that must be made to complete the development. In a rehabilitation project, it is sometimes necessary to make an initial deposit to the reserve for replacement, so that the 20-year capital needs can be met. Partial deferment of fees by the developer appears as deferred developer fees, an offsetting source of funds. The long-term operating pro forma examines income and expenses during a 15- to 20-year period for a project after the development or conversion is complete. These two tools-the development budget (sources and uses statement) and the operating pro forma-work in tandem. The operating pro forma is particularly important for projects requiring debt, because adequate debt service coverage during the term of the loan is essential for attracting lender support. For example, we had to make assumptions about the term and interest rate of the mortgage. The general consensus is that these revenues will not increase over time, but rather will trend downward. Most likely, it would have to resort to alternative financing sources, such as gap soft financing, to meet the capital needs for the project. Sources and Uses Development Budget Exhibit 1 shows the development budget for this project. Raising such a large amount of soft funds could be a challenge, however, and would compete with other uses for these limited funds. Because the gap financing would reduce project borrowing, financing fees and related costs decline by nearly $600,000 (in this instance, mostly from the savings on interest during construction). Many of these items-such as organizational costs, recordation, title insurance, escrow agent fees, and other miscellaneous items that are part of any closing-are required regardless of the existence of a loan. Year 1 ($) 1,381,512 (69,076) 1,312,436 (652,370) (99,000) 561,066 - 561,066 561,066 561,066 Year 10 ($) 1,262,035 (63,102) 1,198,933 (851,195) (99,000) 248,738 - 248,738 362,242 144,046 Year 20 ($) 1,141,362 (57,068) 1,084,294 (1,143,935) (99,000) (158,641) - (158,641) 69,502 (348,860) All Years ($) 25,156,375 (1,257,819) 23,898,556 (17,529,426) (1,980,000) 4,389,130 - 4,389,130 6,739,302 2,302,744 p. Finally, both operating budgets have the same level of contributions to the reserve for replacement ($99,000) in all years. Both scenarios have significant variances in all items except for operating expenses and contributions to reserves. Most likely, these funds will decline over time, as they have during the past decades. Having the same level of capital improvements at the outset allows for operating costs to be treated as equal. With other changes to the assumptions, it becomes nearly impossible to control all the variables and provide a reasonable comparison. We also appreciate the support of Marina Myhre in shepherding this article through the publication process and of John Wehmueller in simplifying our prose. Dennis Stout is Director of Housing and Community Development at Econometrica, Inc. Department of Housing and Urban Development sponsors or cosponsors three annual competitions for innovation in affordable design. Each competition seeks to identify and develop new, forward-looking planning and design solutions for expanding or preserving affordable housing. The competition challenges the students to address social, economic, and environmental issues in response to a specific housing problem developed by a public housing agency. The site-Woodhill Homes-is a 478-unit multifamily development on the outskirts of downtown Cleveland. Although its proximity to the city should generate more economic opportunities for Woodhill Homes residents, the property is isolated from the surrounding neighborhoods, and inadequate transportation options hinder access to the urban core. The distinction of being among the first also brings with it major challenges that the students were asked to address-a decaying landscape that is further hampered by harsh winters, stormwater damage, vandalism, and outdated building materials. As is the case every year, students also had to account for the social and environmental needs of the residents, survey the regulatory environment, consider the conditions of the local housing market, and be familiar with the long-range comprehensive plan. Competition guidelines also required that teams submit proposals responsive to five general elements of design: (1) planning context and analysis, (2) building solutions and technology, (3) equitable development solutions, (4) sitespecific illustrations for new development or redevelopment, and (5) operations and finances. In phase I, a jury of five practitioners, planners, and architects evaluated first-round proposals. This year, 35 teams representing 175 students from various professional graduate schools submitted proposals. Lessons learned from this visit were meant to help students improve their final proposals. Several weeks after the site visit, all jurors and finalists traveled to Washington, D. At the event, the student teams presented their revised project solutions in front of the jury and an audience. After an intense deliberation, the jury selected the team from the Rutgers University as the winner and the team from the University of Michigan at Ann Arbor as the runner-up. First, jurors share the elements of the winning site plans that represented innovative solutions and address whether the proposed solutions could be implemented at Woodhill Homes. The students then reflect on recommendations from the jury, the biggest challenges faced, and how they attempted to address them. They also identify opportunities to learn from mistakes, ideas of what innovation is, elements observed that provided value to the design of the project, and any tradeoffs that had to be made to get to a feasible site plan. As in previous competitions, jurors were instructed to select the proposals that offer the best examples of innovative design and to encourage the students to think outside the box, keeping in full view the feasibility of their ideas. Also, because Woodhill Homes is one of the more challenging projects that we have seen thus far, their task was compounded by the fact that two outstanding proposals were put forward. These ideas and the solutions offered should be highlighted in all aspects of the site plan. Both the Rutgers and Michigan teams needed to be clearer on how they calculated per-unit construction and operating costs; for instance, accounting especially for green features that may have higher upfront costs than expected. Another major consideration Cityscape 489 Gray is the feasibility of tax credit investment, given the conditions of the local housing market and difficulty with securing 4-percent tax credit financing. The students were charged with addressing site and building circulation, deteriorating building materials, parking, and impervious street surfaces that would cause flooding during rainstorms, among other challenges. However, the students were also strongly encouraged to be specific about how their plans enhance social cohesion, create a sense of community, and connect residents to opportunities beyond the Woodhill Homes neighborhood. Among the most innovative aspects of their proposed site plan is the addition of Morris Lofts-a 40-unit building that residents could use for all types of activities, including a space for arts, rooms for training and community development activities, and a place where social workers and other practitioners could help residents address a variety of personal needs. The proposed site plan also includes a place for children and youth activities, as well as a recreational room designated for older adults and seniors.

The Walden University had 47 symptoms 5dpo buy generic seroquel 100mg on-line,456 students in 2010 treatment tendonitis purchase 200mg seroquel amex, while Kaplan University had 77 symptoms juvenile diabetes order 50 mg seroquel with mastercard,966 students treatment zinc deficiency purchase 200mg seroquel otc. Which is better: having a stock that goes up 30% on Monday than drops 30% on Tuesday medicine 101 order 300mg seroquel, or a stock that drops 30% on Monday and goes up 30% on Tuesday? In support of the two wars medicine 832 buy 50 mg seroquel with amex, more than 6,500 American soldiers have lost their lives. During the same period, however, guns have been used to murder about 100,000 people on American soil" 10 23. Suppose you have one quart of water/juice mix that is 50% juice, and you add 2 quarts of juice. A highway had a landslide, where 3,000 cubic yards of material fell on the road, requiring 200 dump truck loads to clear. For the movies in the previous problem, which provided the best return on investment? The population of India is about 1,184,639,000, covering a land area of 1,269,000 square miles. The population of China is about 1,347 million, while the population of Sweden is about 9. Create a comparison to help understand the amount of tweets in a year by imagining each character was a drop of water and comparing to filling something up. After pouring in the milk, you start adding the mix, but get distracted and accidentally put in 5 scoops of mix. After cracking the eggs, you start measuring the sugar, but accidentally put in 4 tablespoons of sugar. Assume an average car gets 20 miles to the gallon, and drives about 12,000 miles in a year. A piece of paper can be made into a cylinder in two ways: by joining the short sides together, or by joining the long sides together 12. In the next 4 questions, estimate the values by making reasonable approximations for unknown values, or by doing some research to find reasonable values. How many gallons of paint would be needed to paint a two-story house 40 ft long and 30 ft wide? During the landing of the Mars Science Laboratory Curiosity, it was reported that the signal from the rover would take 14 minutes to reach earth. How far will a car traveling at 60 miles per hour travel (in feet) before the driver reacts to an obstacle? The flash of lightning travels at the speed of light, which is about 186,000 miles per second. The sound of lightning (thunder) travels at the speed of sound, which is about 750 miles per hour. If you see a flash of lightning, then hear the thunder 4 seconds later, how far away is the lightning? If you stand in a parking lot near a building and sound a horn, you will hear an echo. How much would it cost to fill a swimming pool 4 feet deep, 8 feet wide, and 12 feet long with Jell-O? You read online that a 15 ft by 20 ft brick patio would cost about $2,275 to have professionally installed. You run over to the baking aisle and find a bag of pecans, and look at the nutrition label to gather some info. A packet of sugar (the kind they have at restaurants for your coffee or tea) typically contain 4 grams of sugar in the U. The details may be imprecise; answer the question the best you can with the provided information. I have an old gas furnace, and am considering replacing it with a new, high efficiency model. Janine is considering buying a water filter and a reusable water bottle rather than buying bottled water. Marcus is considering going car-free to save money and be more environmentally friendly. For the next set of problems, research or make educated estimates for any unknown quantities needed to answer the question. You want to paint the walls of a 6ft by 9ft storage room that has one door and one window. How many gallons and/or quarts of paint should you buy to paint the room as cheaply as possible? Just for the materials, is this more expensive than using a more traditional material like ceramic tiles? If each penny has to be laid by hand, estimate how long it would take to lay the pennies for a 12ft by 10ft room. Considering material and labor costs, are pennies a cost-effective replacement for ceramic tiles? You are considering taking up part of your back yard and turning it into a vegetable garden, to grow broccoli, tomatoes, and zucchini. Will doing so save you money, or cost you more than buying vegetables from the store? Barry is trying to decide whether to keep his 1993 Honda Civic with 140,000 miles, or trade it in for a used 2008 Honda Civic. Some people claim it costs more to eat vegetarian, while some claim it costs less. Examine your own grocery habits, and compare your current costs to the costs of switching your diet (from omnivore to vegetarian or vice versa as appropriate). A couple locations are hard to get to by bus, but there is a ZipCar (short term car rental) location within a few blocks. In the United States, federal income taxes help fund the military, the environmental protection agency, and thousands of other programs. While very few people enjoy paying taxes, they are necessary to pay for the services we all depend upon. When taxes are not given as a fixed percentage rate, sometimes it is necessary to calculate the effective rate. Effective rate the effective tax rate is the equivalent percent rate of the tax paid out of the dollar amount the tax is based on. Example 2 Joan paid $3,200 in property taxes on her house valued at $215,000 last year. Tax categories A flat tax, or proportional tax, charges a constant percentage rate. Problem Solving 31 Example 3 the United States federal income tax on earned wages is an example of a progressive tax. For a single person in 2011, adjusted gross income (income after deductions) under $8,500 was taxed at 10%. Notice that the effective rate has increased with income, showing this is a progressive tax. Example 4 A gasoline tax is a flat tax when considered in terms of consumption, a tax of, say, $0. Someone buying 10 gallons of gas at $4 a gallon would pay $3 in tax, which is $3/$40 = 7. Someone buying 30 gallons of gas at $4 a gallon would pay $9 in tax, which is $9/$120 = 7. It is likely that someone earning $30,000 a year and someone earning $60,000 a year will drive about the same amount. If both pay $60 in gasoline taxes over a year, the person earning $30,000 has paid 0. While sales tax is a flat percentage rate, it is often considered a regressive tax for the same reasons as the gasoline tax. Others call for revisions to how different types of income are taxed, since currently investment income is taxed at a different rate than wage income. The following two projects will allow you to explore some of these ideas and draw your own conclusions. The federal government needs to collect $800,000 in income taxes to be able to function. The population consists of 6 groups: Group A: Group B: Group C: Group D: Group E: Group F: 20 households that earn $12,000 each 20 households that earn $29,000 each 20 households that earn $50,000 each 20 households that earn $79,000 each 15 households that earn $129,000 each 5 households that earn $295,000 each this scenario is roughly proportional to the actual United States population and tax needs. Total tax Group Income per Tax rate Income tax Income after collected for all household (%) per taxes per households household household A $12,000 B C D E F $29,000 $50,000 $79,000 $129,000 $295,000 this better total to $800,000 7) Discretionary income is the income people have left over after paying for necessities like rent, food, transportation, etc. The cost of basic expenses does increase with income, since housing and car costs are higher, however usually not proportionally. For each income group, estimate their essential expenses, and calculate their discretionary income. Then compute the effective tax rate for each plan relative to discretionary income rather than income. Scenario 1: Calculate the taxes for someone who earned $60,000 in standard wage income (W-2 income), has no dependents, and takes the standard deduction. Scenario 2: Calculate the taxes for someone who earned $20,000 in standard wage income, $40,000 in qualified dividends, has no dependents, and takes the standard deduction. Based on these three scenarios, what are your impressions of how the income tax system treats these different forms of income (wage, dividends, and business income)? Married with 2 children, filing jointly Wage income: $50,000 combined Paid sales tax in Washington State Property taxes paid: $3200 Home mortgage interest paid: $4800 Charitable gifts: $1200 Voting Theory 35 Voting Theory In many decision making situations, it is necessary to gather the group consensus. This happens when a group of friends decides which movie to watch, when a company decides which product design to manufacture, and when a democratic country elects its leaders. While the basic idea of voting is fairly universal, the method by which those votes are used to determine a winner can vary. In deciding upon a winner, there is always one main goal: to reflect the preferences of the people in the most fair way possible. A traditional ballot usually asks you to pick your favorite from a list of choices. This ballot fails to provide any information on how a voter would rank the alternatives if their first choice was unsuccessful. Preference ballot A preference ballot is a ballot in which the voter ranks the choices in order of preference. Example 1 A vacation club is trying to decide which destination to visit this year: Hawaii (H), Orlando (O), or Anaheim (A). Their votes are shown below: 1 choice 2nd choice 3rd choice st Bob A O H Ann A H O Marv O H A Alice H A O Eve A H O Omar O H A Lupe H A O Dave O H A Tish H A O Jim A H O these individual ballots are typically combined into one preference schedule, which shows the number of voters in the top row that voted for each option: 1 choice 2nd choice 3rd choice st 1 A O H 3 A H O 3 O H A 3 H A O Notice that by totaling the vote counts across the top of the preference schedule we can recover the total number of votes cast: 1+3+3+3 = 10 total votes. Plurality Method In this method, the choice with the most first-preference votes is declared the winner. Ties are possible, and would have to be settled through some sort of run-off vote. This method is sometimes mistakenly called the majority method, or "majority rules", but it is not necessary for a choice to have gained a majority of votes to win. A majority is over 50%; it is possible for a winner to have a plurality without having a majority. Example 2 In our election from above, we had the preference table: 1st choice 2nd choice 3rd choice 1 A O H 3 A H O 3 O H A 3 H A O For the plurality method, we only care about the first choice options. Totaling them up: Anaheim: 1+3 = 4 first-choice votes Orlando: 3 first-choice votes Hawaii: 3 first-choice votes Anaheim is the winner using the plurality voting method. Notice that Anaheim won with 4 out of 10 votes, 40% of the votes, which is a plurality of the votes, but not a majority. Try it Now 1 Three candidates are running in an election for County Executive: Goings (G), McCarthy (M), and Bunney (B) 1. The election from Example 2 may seem totally clean, but there is a problem lurking that arises whenever there are three or more choices. Looking back at our preference table, how would our members vote if they only had two choices? Anaheim just won the election, yet 6 out of 10 voters, 60% of them, would have preferred Hawaii! Marquis de Condorcet, a French philosopher, mathematician, and political scientist wrote about how this could happen in 1785, and for him we name our first fairness criterion. Fairness Criteria the fairness criteria are statements that seem like they should be true in a fair election. Condorcet Criterion If there is a choice that is preferred in every one-to-one comparison with the other choices, that choice should be the winner. Comparing Hawaii to Orlando, we can see 6 out of 10 would prefer Hawaii to Orlando. Even though city council is technically a nonpartisan office, people generally know the affiliations of the candidates. In this election there are three candidates: Don and Key, both Democrats, and Elle, a Republican. A preference schedule for the votes looks as follows: 1st choice 2nd choice 3rd choice 342 Elle Don Key 214 Don Key Elle 298 Key Don Elle We can see a total of 342 + 214 + 298 = 854 voters participated in this election. Analyzing the one-to-one comparisons: Elle vs Don: 342 prefer Elle; 512 prefer Don: Don is preferred Elle vs Key: 342 prefer Elle; 512 prefer Key: Key is preferred Don vs Key: 556 prefer Don; 298 prefer Key: Don is preferred So even though Don had the smallest number of first-place votes in the election, he is the Condorcet winner, being preferred in every one-to-one comparison with the other candidates. Insincere voting is when a person casts a ballot counter to their actual preference for strategic purposes.

Much of what did begin to shift could take several years before significant progress is observable medications like abilify buy generic seroquel 200 mg online, and future assessments of these dynamics would be useful to testing this theory symptoms 9dpo purchase seroquel 50 mg visa. So medications ending in ine purchase seroquel 50mg overnight delivery, certainly symptoms 24 hour flu cheap seroquel 100 mg otc, a reorientation internally that grew out of that medications names and uses buy 50mg seroquel overnight delivery, that interaction outside of our usual silos medicine numbers order seroquel 200 mg mastercard. For these kinds of big planning initiatives, how you set it up will almost always dictate what you end up with. So, if you set up a process whereby the information and the analysis is coming from highly-technical specialists, they have the power-they will have the power in how you define the problem and how you define the solution at the end of the day. This intentionality included establishing a separate body charged with an equity directive. Addressing the history of inequities in the systems we work in and their on-going impacts in our communities is a shared responsibility. Social equity also means that those affected by poverty, communities of color, and historically marginalized communities have leadership and influence in decision making processes, planning, and policy-making. Together we can leverage our collective resources to create communities of opportunity. And that was huge because that definition has become the fallback definition for jurisdictions on equity. In the Puget Sound region, small business interests have a history of influencing regional planning. According to one coalition leader, local business owners could not directly engage with planning processes due to lack of capacity, language barriers, and a lack of knowledge about the process. Some were also skeptical of their potential to influence the planning process due to prior challenges with transit initiatives. One community representative described significant commercial displacement having occurred along a light rail construction corridor and felt a lack of higher-level concern for the shuttered establishments. The project had even less success in stimulating and maintaining engagement of major employers and large business interests. The Puget Sound region attempted to bring historically marginalized communities into the planning process through specific mechanisms in the governance structure, built to ensure community voices were included. Part of this success may have resulted from the decision to use an expert facilitator 102 Planning Livable Communities the Impacts of the Sustainable Communities Initiative Regional Planning Grants on Planning and Equity in Three Metropolitan Regions to equalize power dynamics in the consortium. One was the inaccessibility of technical-planning jargon and its mystified processes, which the consortium tried to overcome through specialized training, capacity-building workshops, and peer networking to help stakeholders understand where to influence the process. Creating this space allowed for important and difficult discussions to take place. A participant from Snohomish County admitted that although "there were some really uncomfortable conversations with people," at the end of the day, they felt their concerns were heard and taken "to heart" by the other government leadership at the table. Not all parts of the region currently benefit from the light rail system, and many are not part of plans for future expansions. They managed all those committees and they kept a pretty tight rein on the kind of communication. The oversight committees were organized by them and they were very scripted agendas. The consortium lead for the grant was the Metropolitan Council (Met Council), the seven-county regional government body serving the nearly 3 million residents of Minneapolis, St. The local political climate was newly supportive of collaboration after decades of competition, especially between St. The notion that equity goals were important was fairly universal, although a shared definition of equity and strategy around achieving those goals was more elusive. The region faced, and continues to face, significant racial disparities and has a history of exclusion of minority voices in public infrastructure decisions and development. Specifically, this context meant that equity goals were advanced in the dialogue and action within key institutions but efforts to maintain a shared definition and priorities around an equity agenda are ongoing. Cityscape 105 Arias, Draper-Zivetz, and Martin On receiving the CoO funding, the Met Council, which typically held authority and decisionmaking power in the region, relinquished much of its control to the policy board. Ensuring community voices were heard became a critical component of the structure of the CoO grant. Although many were doubtful about the authenticity of this approach at first, participants in the CoO were ultimately encouraged: "The Policy Board was really nervous about all of this. Although in their first year the board was largely a racially homogenous group, this lack of diversity was recognized and ultimately led to the recruitment and inclusion of additional individuals, such as Paul Williams, the African-American Deputy Mayor of St. In the Twin Cities, the initiative supported a robust and nuanced conversation around inequities, despite the lack of a dedicated equity-oriented subcommittee. According to a CoO evaluator, "Equity was a big element of everything from the beginning. As a participant from a regional transit agency put it, the consortium "look[ed] at the challenges we faced in shared prosperity, meaning equity in terms of employment, equity in terms of pay, equity in terms of opportunities for business development and business growth. Producing a broadly shared definition of the term, however, continues to be a challenge. Certainly we worked really hard on it, staff and the Policy Board worked on it, and struggled and struggled and struggled. With respect to the business community, existing regional actors helped set the stage for involvement. The Itasca Project-an employer-led alliance that seeks to address regional economic issues in the region-was active and established before CoO and was already playing an influential role in regional planning. In the Twin Cities, the Itasca Project and local chambers of commerce both played this role successfully. Conflicting narratives emerged on the degree of success with which small businesses were brought into the process. Although a few grant participants felt that small businesses had a strong voice at the regional table, several others noted that they were hard to engage and unlikely to even be aware of the regional planning effort. Community members who had previously engaged with power structures in the Twin Cities were generally skeptical of the CoO process, expecting repeated patterns of disconnection and disingenuity. One member of a local advocacy organization described the skepticism and local dynamics at the time the consortium was formed: "We had to overcome that-we had to persuade folks [that] this is a new Met Council, new leadership, a lot of possibilities and potential-but we had to get over this deep-seated suspicion. Jurisdictional Dynamics In the Twin Cities region, the two major municipalities of St. Paul and Minneapolis have a contentious history that can sometimes be characterized as combative, competitive, and distrustful. Paul, as well as between Hennepin and Ramsey Counties (where the respective cities are). A government employee from one of the municipalities said: "It was clear, at that point, that the region was hungry for the cities to quit fighting. Elected officials struggled to balance leadership and decisionmaking that would benefit the region, with loyalty and accountability to more localized interests of their jurisdiction and constituency. I would go back to my community and people would say `Why are you working so hard on this when this is our district? Later, as a research foundation employee explained, an additional suburban mayor was included "to give better voice and a fairer chance of participation [for the suburban communities]. As one elected official put it, "We had a number of different suburban mayors throughout the process, no one mayor committed. And I think that even at some times it was stuff that they were adversarial to , they felt threatened. Paul region is now dedicated to using different models to address varied regional needs-particularly those related to creating jobs and attracting businesses and investment. Many interviewees felt that the culture around community engagement in planning has been fundamentally shifted as a result of the CoO grant program. The first task they set out was to establish regional standards on community engagement. Now they apply it not just to transportation spending but also to all activities of the Met Council. Previously a lone dedicated community engagement officer, the team has grown to five employees drawn from diverse backgrounds including community organizing. Some have turned into full-fledged organizations that have been able to do their own thing now. The willingness, especially early on, for traditionally empowered leaders to hand over decisionmaking may have set the tone for subsequent buy-in and change by other stakeholders. Conclusions From Three Case Studies Thematic Findings and Implications Across our interviews with stakeholders in the Twin Cities, Bay Area, and Puget Sound regions, we identified insights across the themes of equity, stakeholder engagement, and jurisdictional dynamics. Cityscape 109 Arias, Draper-Zivetz, and Martin Equity Central to our research was the concept of equity as a goal to be advanced through regional collaboration. We define equity, as opposed to equality, as fairness in outcomes across race, ethnicity, class, and other status. First, communities and advocates within all regions viewed regional planning efforts to advance equity with skepticism. Second, each region studied made explicit space for equity within the collaborative governance structure-albeit in different forms and with different sequencing in the development of the collaboratives. In the Bay Area, the Equity Collaborative was formed late in the process without clarity of purpose. In the Twin Cities, equity was incorporated through a focus on community engagement and sharing of decisionmaking authority. Similar to the Bay Area, the regional collaborative in the Twin Cities only incorporated this targeted focus on community engagement at the tail end of the application process. In the Puget Sound region, the regional collaborative formed the Regional Equity Network very early on, with an explicit goal of co-creating an equity agenda for the region. These various experiences show the importance of both creating a space explicitly focused on equity and of clearly defining the goals and mechanisms through which an equity agenda will be articulated. Our interviews revealed that regions often struggled to arrive to a shared definition of equity. In the Puget Sound and the Twin Cities regions, however, the conversation was more explicit about race. The Twin Cities in particular was particularly race conscious, with racial disparities often cited as a structural problem with which the region needed to grapple. Only in the Puget Sound region, however, was defining a regional equity agenda a priority, which was locally lauded as a significant win. Stakeholder Engagement We were also interested in the extent to which various stakeholder groups were engaged in the regional planning process. Where distrust and animosity already existed, local entities struggled to 110 Planning Livable Communities the Impacts of the Sustainable Communities Initiative Regional Planning Grants on Planning and Equity in Three Metropolitan Regions meaningfully collaborate across silos. With respect to the former, existing dynamics often determined the extent to which businesses were successfully engaged. Grantees differentiated among larger corporations, smaller neighborhood businesses, real estate developers, and regional or statewide business associations. The increased partnership of larger business associations or alliances, such as the Itasca Project in the Twin Cities, is key to long-term regional success, whereas small business engagement was most often critical in mitigating harm to commercial districts during transit infrastructure expansion. Common challenges to authentic and inclusive public engagement across all three regions included a historic distrust of regional planning (as mentioned previously), the inaccessibility of planning jargon, and limited resources and staff capacity to engage. This institutional mechanism for community-led decisionmaking can also help combat the historic distrust of government. Jurisdictional Dynamics Lastly, we compared how regions fared in promoting increased collaboration across different municipalities and levels of governance. In some case, the relationships were more focused on cross-jurisdictional learning than actual collaboration. In regions like the Bay Area, which are very decentralized, some felt collaboration was too spread out to be coherent. In regions that are more tightly defined, as in the Puget Sound and the Twin Cities, suburban jurisdictions often felt excluded and ended up largely sitting out of the collaborative process. First, planning priorities in core cities were different from those in suburban jurisdictions. Indeed, all regions grappled with getting locally elected officials to act in the interest of the broader region. Local interests were often at odds with regional interests, which presented some naturally limiting constraints to advancing a regional agenda. Although that may seem obvious, this nuance complicates how the implementation of a national grant program lands in regions with many different contexts. Lastly, supporting the influence or efficacy of regional governance bodies is an important way of ensuring local interests do not consistently override regional needs. Acknowledgments the authors thank Karen Chapple for her guidance and support in this process, the Surdna Foundation and Ford Foundation for their financial support of the project, and, for their partnership in this research, their 2016 classmates: Samantha Beckerman, Genise Choy, Joni Hirsch, Dov Kadin, Colleen Kredell, Joseph Poirier, Kristine Williams, and James Yelen. They also thank the interviewees of all organizations, but especially those with limited capacity and budget, for taking the time to discuss this experience and for their collective ongoing work in their regions to advance equity and collective impact in the planning process. Sara Draper-Zivetz is the Associate Director of the Terner Center for Housing Innovation at the University of California, Berkeley. Cityscape 113 Arias, Draper-Zivetz, and Martin Additional Reading Basolo, Victoria. Gough Virginia Commonwealth University Jason Reece the Ohio State University Abstract In 2010 and 2011, the U. The grants supported 3-year regional planning efforts that prioritized inclusive processes and addressed the interdependent challenges of economic prosperity, social equity, and environmental protection. However, we question the potential for plan implementation and continuation of these outcomes. We conclude with implications for planning and policy, and we offer recommendations for future federal large-scale planning programs. Each grant supported a 3-year regional planning effort that prioritized inclusive processes and the intent to address the interdependent challenges of economic prosperity, social equity, and environmental protection. Economically distressed communities received extra points in the application review, in accordance with the federal goal of removing regulatory and policy barriers to sustainable community development in distressed areas. Most successful regions dedicated considerable time preparing the grant application, which required working together to coordinate interest, outline goals, and detail ways in which representatives from the different jurisdictions and sectors would make decisions and carry out the regional planning efforts (Chapple and Mattiuzzi, 2013).

Food Insecurity Prevalence and Usual Care Given the Family Options Study participation criterion that families must have spent at least 7 days in emergency shelter prior to enrollment kapous treatment 100mg seroquel otc, it is not surprising that the prevalence of household food insecurity among participating households was very high treatment yeast cheap 50 mg seroquel amex. During the period of 2012 to 2015 the treatment 2014 online generic seroquel 50 mg fast delivery, when most participating families would have completed their time in the study treatment quadriceps strain discount 200mg seroquel with mastercard, the average household food security rate in the United States ranged from 14 medications safe during pregnancy order 50 mg seroquel mastercard. Nationally treatment xanthelasma eyelid buy cheap seroquel 200mg line, families with incomes below the federal poverty level are those most comparable to Family Options Study families-the rates among these families ranged from 40. However, the improvements were no longer apparent at the 37-month mark, suggesting that, although temporary household assistance that in effect boosted household income for a limited period might have provided some respite to economic pressures, it was not sufficient to position families on a more economically stable path for the longer term. Interestingly, housing outcomes were also largely insignificant at 20 and 37 months. It is also possible that the quality of case management supports and other services in these programs was variable, making it difficult to detect any impact. However, given the striking findings on the impact of a permanent housing subsidy on food insecurity and many other outcomes, as discussed in the following subsection, it is also likely that the length of assistance was simply insufficient to help these families overcome the multiple material hardships they faced and that the associated services were not able to compensate for the resource constraints these families faced. Priority access to a permanent housing subsidy significantly reduced the rates of household food insecurity among families when compared with usual care. This impact was achieved despite the fact that vouchers were not accompanied by any supportive services. As a result, without further scrutiny, program participation can often have the perverse appearance of exacerbating food insecurity. In addition, underreporting of program participation in surveys may also create a problem of measurement that is not random. In recent years, rigorous scholarship has sought to correct for these challenges, allowing for greater confidence in the assessment of the positive benefits of nutrition program participation for reducing food insecurity. At least part of the explanation for the insufficient progress in boosting food security lies within the findings of the Family Options Study. This landmark research shows that, when financial pressures created by housing costs are alleviated, the cycle of tradeoffs between paying for basic needs like housing and food can be disrupted, resulting in multiple improvements in individual and communal wellbeing. Unfortunately, without adequate policy investment in affordable housing, the prospects for reducing material hardship are not good. Moreover, housing affordability issues have begun to affect those with moderate incomes as well, increasing the potential pool of those renters who may face insufficient resources to meet basic needs, especially during economic downturns. Those interested in improving the ability of families to afford an adequate healthy diet must consider how the lack of affordable housing options is undermining their existing efforts to reduce hardship and improve outcomes for vulnerable families. The insights provided by the Family Options Study are particularly critical for the current policy and practice environment for a number of reasons. First, at a time when various safety net programs may be at risk of significant cuts, it is necessary to elevate evidence that suggests how underinvesting in rigorously evaluated policies in one domain-for example, housing subsidies-can contribute to negative consequences for other essential areas of family well-being, like food security. Although providers on the ground are often aware of the multifaceted challenges their clients face, they are also often struggling with their own resource constraints and typically focused on maximizing the set of tools in their specific domain. Although they may sometimes seek partnerships that connect clients with services provided by other programs (for example, low-income housing developments may invite food banks to distribute food to residents on site, or food pantries may make referrals to housing services coordinators), they rarely operate with a clear understanding of how policy and program investments in one domain can create significant improvements in their own. Finally, although the results of the Family Options Study in improving both housing and food security outcomes are impressive, it is instructive to remember that many of these families remain quite vulnerable. Commentary: the Family Options Study and Food Insecurity Acknowledgments the author thanks Mary Cunningham and Josh Leopold for their helpful comments and Meg Thompson for assistance with manuscript preparation. Author Elaine Waxman is a senior fellow in the Income and Benefits Policy Center at the Urban Institute. Casey, Patrick, Susan Goolsby, Carol Berkowitz, Deborah Frank, John Cook, Diana Cutts, Maureen M. Cook, Joni Geppert, Stephanie Ettinger de Cuba, Timothy Heeren, Sharon Coleman, Ruth Rose-Jacobs, and Deborah A. Brown, Steven Brown, Lauren Dunton, Winston Lin, Debi McInnis, Jason Rodriguez, Galen Savidge, and Brooke E. Cityscape 241 Waxman Gubits, Daniel, Marybeth Shinn, Michelle Wood, Stephen Bell, Samuel Dastrup, Claudia D. Sandel, Megan, Diana Cutts, Alan Meyers, Stephanie Ettinger de Cuba, and Sharon Coleman. Tarasuk, Valerie, Joyce Cheng, Claire de Oliveira, Naomi Dachner, Craig Gundersen, and Paul Kurdyak. Commentary: Insights From the Family Options Study Regarding Housing and Intimate Partner Violence Nicole E. Allen University of Illinois at Urbana-Champaign Abstract the Family Options Study examines four approaches to addressing homelessness: permanent housing subsidy, rapid re-housing, transitional housing, and usual care (Gubits et al. Indeed, the availability of emergency and transitional housing has been fundamental to the safety of women and children fleeing abusive partners, and housing is a common unmet need for women seeking support services following abuse (Allen, Bybee, and Sullivan, 2004; Allen, Larsen, and Walden, 2011; Schechter, 1982; Sullivan, and Gillum, 2001). In addition, this study demonstrates that separations from partners may become more likely when permanent housing subsidies are provided. It makes sense that a permanent housing subsidy that makes housing more financially viable in the long term would produce positive outcomes. A permanent housing subsidy may avoid an unrealistic timeline for achieving stable housing without a subsidy. Rapid re-housing may move too quickly toward independence and outpace the needs of survivors, not offering sufficient time to work through the longer-term effects of chronic trauma, some of which may emerge more acutely once a survivor has stable housing (Sullivan and Olsen, in press). Finally, a permanent housing subsidy addresses the persistent challenges of living with limited financial resources, an unmet need that can be compounded by having an abusive partner (Roschelle, 2008). For families experiencing acute crisis, transitional housing services may be particularly important. These challenges may include, for example, navigating the legal system and child protection, seeking affordable and safe housing (which may involve moving to a different community), and addressing the acute effects of trauma. For some survivors, transitional housing may be important because it can provide intensive support to address these and other challenges. Comprehensive Assessment of Intimate Partner Violence Although the Family Options Study highlights some important findings, good reasons exist to view these findings as preliminary and in need of further investigation. These measures are often critiqued as acontextual; that is, they often fail to capture the circumstances in which different forms of force were used and the extent to which issues of power and control were imbued in those actions (Lehrner and Allen, 2014). Still, these measures have the benefit of asking specific behavioral questions (for example, "My partner punched or kicked or beat me up") to assess potentially abusive experiences rather than relying on summary judgments about whether or not someone believes they have experienced abuse (that is, "Have you been physically abused in the last 6 months? Cityscape 247 Allen It is always a challenge in a comprehensive study to ask about everything that would be of potential interest regarding the health and well-being of families. The item asks the adult respondent if he or she has been "physically abused or threatened with violence by a person with whom he/she was romantically involved" (Gubits et al. When we are using global items that assess physical abuse and threats of violence, we rely on the participant to encode their experience as abusive, threatening, or violent. Undoubtedly, some participants will do this as an accurate reflection of their lived experience. However, some will not label their experiences as abusive or threatening, although those behaviors may constitute abuse if they were assessed via a behavior-based measure. In the Family Options Study, the item employed did not vary across conditions or time, so no reason exists to believe that cross-condition or cross-time differences in how the item was understood would occur. The global item used in the Family Options Study focuses on physical abuse and threats of violence. These terms may not capture nonphysical forms of abuse and ongoing patterns of coercive control that do not include physical assault but can have profound implications for well-being and housing stability. As an example, imagine a survivor whose abusive partner has never physically assaulted her or overtly threatened her. Instead, her abusive partner carefully regulates her schedule, including when she gets up in the morning, what she eats, where she goes, and so on. He monitors her and makes it clear that deviations from her routine will have consequences. His behavior constitutes coercive control, even in the absence of threats to her physical safety, that can have consequences for psychological health and well-being (Stark, 2009). These types of abusive patterns can be hard to assess even with the best measurement tools available and are especially difficult to discern when a one-item assessment is employed. Further, forms of abusive behavior may vary over time, and a single-item measure may not capture that evolution (for example, a shift from physical abuse to psychological abuse). For some survivors, physical violence may desist, but stalking and other forms of harassment (for example, unwanted contact) may continue. Finally, the single-item measure may miss important findings regarding the frequency and severity of abuse. The best housing options for survivors may depend on how nature of the abuse they are experiencing, and how acute the experience of violence is. Thus, although the Family Options Study points us to the potential value of permanent housing subsidies, targeted research with survivors will be essential to better understanding how to meet their varied circumstances and needs. As research in this area continues, future studies will, ideally, examine abuse experiences over time with attention to a comprehensive assessment of the various forms of violence survivors experience, how those forms of violence may change over time, and the frequency and severity of the violence. Commentary: Insights From the Family Options Study Regarding Housing and Intimate Partner Violence Partner Separation as a Complex Outcome Partners who had abusive partners at baseline were more likely to separate from partners at 37 months (r =. On the one hand, for those survivors who wanted to separate, this outcome is positive. This risk could actually require short-term adjustments that could jeopardize stable housing. For example, given acute safety risks, emergency shelter may be warranted following a separation from an abusive partner. Separation from a partner could actually complicate housing stability, at least in the short term, and housing policy should accommodate these disruptions as they are caused by the perpetration of abusive behavior, not the survivor. Second, sometimes leaving a partner is framed as a naturally desirable endpoint, but, in fact, many survivors who have separated from an abusive partner continue to experience abuse (Fleury, Sullivan, and Bybee, 2000). Also, survivors may not choose to remain separated as they negotiate their safety and well-being. It is essential that remaining with or leaving a partner never become a condition of services rendered or housing benefits offered or maintained. As best practices in the response to homelessness men have evolved, expectations for domestic violence shelter programs, and thus homelessness services for survivors (who are disproportionately women), have changed. For example, some domestic violence programs report reduced funding for transitional housing due to policy changes that followed empirical support for best practices. A survivor-centered process aims to empower women and honor their central decisionmaking role as Cityscape 249 Allen they navigate their safety and well-being. In their review of the many policy changes that emerged following the Violence Against Women Act,2 Messing et al. Thus, a permanent subsidy for new housing would not be well-suited to their needs, whereas flexible financial support may keep survivors stably housed without an ongoing subsidy. Sullivan and Olsen (in press) also noted that, once survivors are stably housed, the effects of trauma might compound. That is, housing stability may allow for the emotional strain of experiencing trauma to surface. Thus for some, not all, women, support may be essential to successfully maintaining housing. Flexible processes that enable that support when survivors want it may be more prudent than pushing survivors into a particular approach to housing. The study finds that, under conditions of high acute psychosocial need, transitional housing may be a critical first step. Under conditions of lower psychosocial need, permanent housing subsidy may be a better approach. Indeed, previous research suggests that survivors with multiple barriers, including, for example, mental health issues, substance use, or engagement in prostitution, find it more difficult to access needed resources and may require more initial support (Zweig, Schlichter, and Burt, 2002). Along the same lines, proponents of housing first also emphasize that the model works best when the match between individuals presenting needs and the housing model employed is strong (Gaetz, Scott, and Gulliver, 2013). Commentary: Insights From the Family Options Study Regarding Housing and Intimate Partner Violence Conclusion the Family Options Study is an important large-scale research effort to inform housing policy to respond effectively to homelessness. More accessible permanent housing subsidies appear to have promise, and transitional housing may be valuable for those with greater initial psychosocial needs. Importantly, such shifts in housing policy represent structural changes rather than individual-level changes. As Sokoloff and Dupont (2005: 44) noted, the "the lack of adequate institutional support in the form of social services and public housing. Taking a survivor-centered, flexible approach is warranted, particularly as the evidence for the most effective housing policy is still in development. Sullivan for providing papers in press that pertained to this important topic and informed this review. Allen is a Julian Rappaport Professorial Scholar and Associate Head/Director of Graduate Studies in the Department of Psychology at the University of Illinois at Urbana-Champaign. Listening to Battered Women: A Survivor-Centered Approach to Advocacy, Mental Health, and Justice. The Washington State Domestic Violence Housing First Program: Cohort 2 Agencies Final Evaluation Report. Pavao, Joanne Jennifer Alvarez, Nikki Baumrind, Marta Induni, and Rachel Kimerling. Commentary: Insights From the Family Options Study Regarding Housing and Intimate Partner Violence Rollins, Chiquita, Nancy E. Housing, Citizenship, and Communities for People With Serious Mental Illness: Theory, Research, Practice, and Policy Perspectives. Commentary: Implications From the Family Options Study for Homeless and Child Welfare Services Patrick J. Louis Abstract the Family Options Study provides an unprecedented opportunity to investigate the troubling link between family homelessness and child maltreatment.

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