Tuesday, July 31, 2012

Payday Lenders Move Loans to Avoid Law

As I've noted on this page in the past, Rev. Gerald Britt leads the way in the public policy work orchestrated by CitySquare.  Among the issues we've tackled is the impact of payday lenders on low-income persons and households. 

Earlier this year the Dallas City Council, led by Council Member Jerry Allen, passed two of the most restrictive payday lending ordinances in the nation.  We are most grateful for Mr. Allen's leadership on this crucial issue.

Now, to avoid compliance with the new laws, payday lending companies are moving their loans into suburban offices where the limits on operations are not yet in place. 

You will be able to view a report by WFAA Channel 8 on the issue and recent developments here or in the frame below. 

The fight continues!

Monday, July 30, 2012

Poverty--understanding scale

The following appeared in Blacklisted News.  Lots to think about here!

100 Million Poor People In America And 39 Other Facts About Poverty That Will Blow Your Mind
July 25, 2012
American 20-dollar bill folded to "show" the World Trade Center crumbling
Every single day more Americans fall into poverty. This should deeply alarm you no matter what political party you belong to and no matter what your personal economic philosophy is. Right now, approximately 100 million Americans are either “poor” or “near poor.”  For a lot of people “poverty” can be a nebulous concept, so let’s define it. 

The poverty level as defined by the federal government in 2010 was $11,139 for an individual and $22,314 for a family of four. Could you take care of a family of four on less than $2000 a month? Millions upon millions of families are experiencing a tremendous amount of pain in this economy, and no matter what “solutions” we think are correct, the reality is that we all should have compassion on them. Sadly, things are about to get even worse. . . .

The following are 40 facts about poverty in America that will blow your mind….

#1 In the United States today, somewhere around 100 million Americans are considered to be either “poor” or “near poor”.

#2 It is being projected that when the final numbers come out later this year that the U.S. poverty rate will be the highest that it has been in almost 50 years.

#3 Approximately 57 percent of all children in the United States are living in homes that are either considered to be either “low income” or impoverished.

#4 Today, one out of every four workers in the United States brings home wages that are at or below the poverty level.

#5 According to the Wall Street Journal, 49.1 percent of all Americans live in a home where at least one person receives financial benefits from the government. Back in 1983, that number was below 30 percent.

#6 It is projected that about half of all American adults will spend at least some time living below the poverty line before they turn 65.

#7 Today, there are approximately 20.2 million Americans that spend more than half of their incomes on housing. That represents a 46 percent increase from 2001.

#8 During 2010, 2.6 million more Americans fell into poverty. That was the largest increase that we have seen since the U.S. government began keeping statistics on this back in 1959.

#9 According to the U.S. Census Bureau, the percentage of “very poor” rose in 300 out of the 360 largest metropolitan areas during 2010.

#10 Since Barack Obama became president, the number of Americans living in poverty has risen by 6 million and the number of Americans on food stamps has risen by 14 million.

#11 Right now, one out of every seven Americans is on food stamps and one out of every four American children is on food stamps.

#12 It is projected that half of all American children will be on food stamps at least once before they turn 18 years of age.

#13 The poverty rate for children living in the United States is 22 percent, although when the new numbers are released in the fall that number is expected to go even higher.

#14 One university study estimates that child poverty costs the U.S. economy 500 billion dollars a year.

#15 Households that are led by a single mother have a 31.6% poverty rate.

Continue reading here.

Sunday, July 29, 2012

A real welcome!

I picked this up from Jon Acuff's blog page (Stuff Christians Like).  This is the sort of church that connects with people at a very deep level over time. 

What do you think?

Here's what “Our Lady of Lourdes Catholic Community” prints in its church buletin as a way to let people know what they are all about: 

We extend a special welcome to those who are single, married, divorced, gay, filthy rich, dirt poor, yo no habla Ingles. We extend a special welcome to those who are crying new-borns, skinny as a rail or could afford to lose a few pounds.

We welcome you if you can sing like Andrea Bocelli or like our pastor who can’t carry a note in a bucket. You’re welcome here if you’re “just browsing,” just woke up or just got out of jail. We don’t care if you’re more Catholic than the Pope, or haven’t been in church since little Joey’s Baptism.

We extend a special welcome to those who are over 60 but not grown up yet, and to teenagers who are growing up too fast. We welcome soccer moms, NASCAR dads, starving artists, tree-huggers, latte-sippers, vegetarians, junk-food eaters. We welcome those who are in recovery or still addicted. We welcome you if you’re having problems or you’re down in the dumps or if you don’t like “organized religion,” we’ve been there too.

If you blew all your offering money at the dog track, you’re welcome here. We offer a special welcome to those who think the earth is flat, work too hard, don’t work, can’t spell, or because grandma is in town and wanted to go to church.

We welcome those who are inked, pierced or both. We offer a special welcome to those who could use a prayer right now, had religion shoved down your throat as a kid or got lost in traffic and wound up here by mistake. We welcome tourists, seekers and doubters, bleeding hearts … and you!

Saturday, July 28, 2012

When poverty was a real concern. . .

These days, politicians and public officials seldom make an issue out of the concerns, needs and tough issues facing poor and low-income persons.

That has not always been the case in American politics. Here's a campaign ad from 1964.

How do you think it would play today?


Friday, July 27, 2012

Senior Citizens and Food Stamps

The following report appeared in The Houston Chronicle.  Critics of the U. S. Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) seldom consider the benefit of the program to hungry, low-income persons, as well as to the overall local economy. 

More Texas seniors receiving food stamps
At age 64, Paulette Lanius is a "Golden Boomer" - one of the 76 million American babies born after World War II, a legacy of the legions of men and women described as the Greatest Generation.

But the future for this Houston woman and thousands of other seniors appears to be far from great.
The fastest-growing group of Texans receiving food stamps is the 60-64 age bracket. In the past six years, those residents receiving food assistance - now issued in the form of a benefit debit card - has jumped by 106 percent to 85,000 as of this month, according to the Texas Health and Human Services Commission. The total number of recipients from all age groups has increased 58 percent.

Authorities say seniors now applying for food stamps often complain of losing their retirement nest eggs in the economic downturn and finding their age to be a distinct disadvantage in finding work. Increasing food prices are also a factor.

Lanius, who once earned a comfortable $65,000 a year as an office manager for a small oil company, was used to donating items to charitable organizations like Second Blessing in west Houston.

'Humbling experience'
But now for the first time in her life, she has not only become a beneficiary of others' generosity at Second Blessing, but she was also enrolled in the food stamp program there. "It's a very humbling experience," she said. "I never dreamed I'd be doing this."

After working nearly 18 years for the same company, she was laid off about two years ago when her employer went into receivership after a storm destroyed two oil platforms. She has not been able to land a steady job since then, forcing her to file early for Social Security and spend through her savings.

"I recently applied for a job at a frozen yogurt store. They'll probably look at the old salary listed on my resume and laugh," she said. "Employers look at people like me and think we'll only work a couple years longer which is not true."

She also represents those boomers identified as the "sandwich generation," because they help support their grown children and aging parents. In her case, her daughter lost her job and moved back home with four children.

Betsy Ballard, spokeswoman for the Houston Food Bank that serves southeast Texas, said her agency has not just seen an onslaught of boomer clients hitting area food banks but many of these people are also applying for food stamps.

107 percent increase
In the past eight months, her agency has interviewed 641 people in their 60s who applied for the debit card. This represents a 107 percent increase over the number that had applied during the same period a year earlier.

"We see this as a fairly significant change since the number of total applications we've filled out for all age groups has shrunk by 1,300," she said.

Still, the total number of Texas participants in the food stamp program (now called the Supplemental Nutrition Assistance Program or SNAP) stands at 3.6 million, which dwarfs the 85,000 enrolled in the 60-64 age bracket.

Yet the growth of the senior group has been outstripping all other age groups since 2007, said Stephanie Goodman, Texas Health and Human Service Commission spokeswoman.

In the past, many of the boomer generation shied away from charity, which they saw as a last resort, said Tiffany Wyatt, spokeswoman for the Catholic Charities community center in Richmond.
"But today some can't afford that kind of pride," said Telecia Rittiman, a social worker for Meals on Wheels.

Billie Jean Robinson, a 63-year-old who lives in the Acres Home area, said she started receiving food stamps nine months ago after her husband of 37 years divorced her. She said she was then no longer able to survive on her small disability check. Even with the $80 monthly debit card for food, she still is behind on her rent and received an eviction notice.

But she's not going hungry: "I can eat now without having to ask people for help."

Retirement plans
A recent Associated Press survey found more than half of baby boomers anticipate retiring later than planned because of significant investment losses during the economic collapse. In fact, a fourth of those surveyed said they would never be able to retire.

Those seniors trying to find work say they're also hitting an invisible age barrier.
One 60-year-old food stamp recipient, Rose Drones, of Channelview, who lost her job as a certified nurse assistant after her car broke down, said, "People don't want to take a chance on you when you're older."

She now earns $200 every two weeks as a receptionist assisting visitors at the Denver Harbor community center looking for the same kind of help she needs.

Nationally, the unemployment rate for seniors, ages 60-64, is 6 percent - a percentage point lower than the rate for those ages 25 to 54. But the seniors saw a faster spike as their unemployment rate has zoomed 100 percent higher than it was five years ago.


Thursday, July 26, 2012

Truth or Lies at dusk on an urban corner

I didn't see her coming.

We were standing outside a crowded restaurant in downtown Philadelphia waiting to get in for dinner.

Out of nowhere the woman appeared, almost like she "materialized" before our eyes.

"Sir, I need fare back to New Jersey," she began an all too familiar pitch to me.

"How much is that?" I asked, not making much effort to cover my frustration--come on, it's my vacation!

"Fourteen dollars for bus and train," she spoke clearly with confidence mixed with z frustration much more deeply seated than mine.

The woman was dressed with care, a poor lady at the end of her disappointing day and her rope most likely.

"I was a fool, sir. I came over here to meet my ex and he just put me out of the car on this street and I can't get home without some help," she went on.

By now we'd attracted a crowd, all listening attentively. I motioned her aside and moved closer so we could hear without raising our voices.

After getting a few more details of her story and her need, I challenged her.

"You need to know that I work with folks in trouble and on the streets in Dallas," I informed her. "I don't think your story adds up. I think you may be lying to me," I pushed her hard.

She never wavered.

"Sir, I have told you the truth," she assured me, looking right into my eyes.

"I don't have the ability to know that, but you do," I replied. I handed her $20 and pressed again that she knew what was true.

"I would rather give you what you say you need not knowing if you're telling me the truth than to refuse your request and chance it that you might just be sharing exactly what happened to you," I explained.

She assured me again that she was speaking the truth.

"One last question," I said as we prepared to part.

"OK," she said.

"Why did you pick us to talk to out of all these folks?" I asked.

"I don't really know," she answered. "Maybe it was God."

She turned and headed toward the subway entrance into the rest of her night.

Do you believe in angels, heavenly guests?

Wednesday, July 25, 2012

Back to the 60s

In this July 16, 2012, photo, Laura Fritz, 27, left, with her daughter Adalade Goudeseune fills out a form at the Jefferson Action Center, an assistance center in the Denver suburb of Lakewood. Both Fritz grew up in the Denver suburbs a solidly middle class family, but she and her boyfriend, who has struggled to find work, and are now relying on government assistance to cover food and $650 rent for their family. The ranks of America's poor are on track to climb to levels unseen in nearly half a century, erasing gains from the war on poverty in the 1960s amid a weak economy and fraying government safety net. Census figures for 2011 will be released this fall in the critical weeks ahead of the November elections. (AP Photo/Kristen Wyatt)

Last week the following grim report put the spotlight on what we've known for a decade here at CitySquare.  Namely, poverty has been on a steady rise since the early 2000s.  The numbers explain our dramatic increase in persons seeking us out for assistance.  We can do better than this, can't we?


US poverty on track to rise to highest since 1960s

Census figures for 2011 will be released this fall in the critical weeks ahead of the November elections.

The Associated Press surveyed more than a dozen economists, think tanks and academics, both nonpartisan and those with known liberal or conservative leanings, and found a broad consensus: The official poverty rate will rise from 15.1 percent in 2010, climbing as high as 15.7 percent. Several predicted a more modest gain, but even a 0.1 percentage point increase would put poverty at the highest level since 1965.

Poverty is spreading at record levels across many groups, from underemployed workers and suburban families to the poorest poor. More discouraged workers are giving up on the job market, leaving them vulnerable as unemployment aid begins to run out. Suburbs are seeing increases in poverty, including in such political battlegrounds as Colorado, Florida and Nevada, where voters are coping with a new norm of living hand to mouth.

"I grew up going to Hawaii every summer. Now I'm here, applying for assistance because it's hard to make ends meet. It's very hard to adjust," said Laura Fritz, 27, of Wheat Ridge, Colo., describing her slide from rich to poor as she filled out aid forms at a county center. Since 2000, large swaths of Jefferson County just outside Denver have seen poverty nearly double.

Fritz says she grew up wealthy in the Denver suburb of Highlands Ranch, but fortunes turned after her parents lost a significant amount of money in the housing bust. Stuck in a half-million dollar house, her parents began living off food stamps and Fritz's college money evaporated. She tried joining the Army but was injured during basic training.

Now she's living on disability, with an infant daughter and a boyfriend, Garrett Goudeseune, 25, who can't find work as a landscaper. They are struggling to pay their $650 rent on his unemployment checks and don't know how they would get by without the extra help as they hope for the job market to improve.

In an election year dominated by discussion of the middle class, Fritz's case highlights a dim reality for the growing group in poverty. Millions could fall through the cracks as government aid from unemployment insurance, Medicaid, welfare and food stamps diminishes.

"The issues aren't just with public benefits. We have some deep problems in the economy," said Peter Edelman, director of the Georgetown Center on Poverty, Inequality and Public Policy.

He pointed to the recent recession but also longer-term changes in the economy such as globalization, automation, outsourcing, immigration, and less unionization that have pushed median household income lower. Even after strong economic growth in the 1990s, poverty never fell below a 1973 low of 11.1 percent. That low point came after President Lyndon Johnson's war on poverty, launched in 1964, that created Medicaid, Medicare and other social welfare programs.

"I'm reluctant to say that we've gone back to where we were in the 1960s. The programs we enacted make a big difference. The problem is that the tidal wave of low-wage jobs is dragging us down and the wage problem is not going to go away anytime soon," Edelman said.

Stacey Mazer of the National Association of State Budget Officers said states will be watching for poverty increases when figures are released in September as they make decisions about the Medicaid expansion. Most states generally assume poverty levels will hold mostly steady and they will hesitate if the findings show otherwise. "It's a constant tension in the budget," she said.

The predictions for 2011 are based on separate AP interviews, supplemented with research on suburban poverty from Alan Berube of the Brookings Institution and an analysis of federal spending by the Congressional Research Service and Elise Gould of the Economic Policy Institute.

The analysts' estimates suggest that some 47 million people in the U.S., or 1 in 6, were poor last year. An increase of one-tenth of a percentage point to 15.2 percent would tie the 1983 rate, the highest since 1965. The highest level on record was 22.4 percent in 1959, when the government began calculating poverty figures.

Poverty is closely tied to joblessness. While the unemployment rate improved from 9.6 percent in 2010 to 8.9 percent in 2011, the employment-population ratio remained largely unchanged, meaning many discouraged workers simply stopped looking for work. Food stamp rolls, another indicator of poverty, also grew.

Demographers also say:
—Poverty will remain above the pre-recession level of 12.5 percent for many more years. Several predicted that peak poverty levels — 15 percent to 16 percent — will last at least until 2014, due to expiring unemployment benefits, a jobless rate persistently above 6 percent and weak wage growth.
—Suburban poverty, already at a record level of 11.8 percent, will increase again in 2011.
—Part-time or underemployed workers, who saw a record 15 percent poverty in 2010, will rise to a new high.
—Poverty among people 65 and older will remain at historically low levels, buoyed by Social Security cash payments.
—Child poverty will increase from its 22 percent level in 2010.

Analysts also believe that the poorest poor, defined as those at 50 percent or less of the poverty level, will remain near its peak level of 6.7 percent.

"I've always been the guy who could find a job. Now I'm not," said Dale Szymanski, 56, a Teamsters Union forklift operator and convention hand who lives outside Las Vegas in Clark County. In a state where unemployment ranks highest in the nation, the Las Vegas suburbs have seen a particularly rapid increase in poverty from 9.7 percent in 2007 to 14.7 percent.

Szymanski, who moved from Wisconsin in 2000, said he used to make a decent living of more than $40,000 a year but now doesn't work enough hours to qualify for union health care. He changed apartments several months ago and sold his aging 2001 Chrysler Sebring in April to pay expenses.
"You keep thinking it's going to turn around. But I'm stuck," he said.

The 2010 poverty level was $22,314 for a family of four, and $11,139 for an individual, based on an official government calculation that includes only cash income, before tax deductions. It excludes capital gains or accumulated wealth, such as home ownership, as well as noncash aid such as food stamps and tax credits, which were expanded substantially under President Barack Obama's stimulus package.

An additional 9 million people in 2010 would have been counted above the poverty line if food stamps and tax credits were taken into account.

Robert Rector, a senior research fellow at the conservative Heritage Foundation, believes the social safety net has worked and it is now time to cut back. He worries that advocates may use a rising poverty rate to justify additional spending on the poor, when in fact, he says, many live in decent-size homes, drive cars and own wide-screen TVs.

A new census measure accounts for noncash aid, but that supplemental poverty figure isn't expected to be released until after the November election. Since that measure is relatively new, the official rate remains the best gauge of year-to-year changes in poverty dating back to 1959.

Few people advocate cuts in anti-poverty programs. Roughly 79 percent of Americans think the gap between rich and poor has grown in the past two decades, according to a Public Religion Research Institute/RNS Religion News survey from November 2011. The same poll found that about 67 percent oppose "cutting federal funding for social programs that help the poor" to help reduce the budget deficit.

Outside of Medicaid, federal spending on major low-income assistance programs such as food stamps, disability aid and tax credits have been mostly flat at roughly 1.5 percent of the gross domestic product from 1975 to the 1990s. Spending spiked higher to 2.3 percent of GDP after Obama's stimulus program in 2009 temporarily expanded unemployment insurance and tax credits for the poor.

The U.S. safety net may soon offer little comfort to people such as Jose Gorrin, 52, who lives in the western Miami suburb of Hialeah Gardens. Arriving from Cuba in 1980, he was able to earn a decent living as a plumber for years, providing for his children and ex-wife. But things turned sour in 2007 and in the past two years he has barely worked, surviving on the occasional odd job.

His unemployment aid has run out, and he's too young to draw Social Security.

Holding a paper bag of still-warm bread he'd just bought for lunch, Gorrin said he hasn't decided whom he'll vote for in November, expressing little confidence the presidential candidates can solve the nation's economic problems. "They all promise to help when they're candidates," Gorrin said, adding, "I hope things turn around. I already left Cuba. I don't know where else I can go."
Associated Press writers Kristen Wyatt in Lakewood, Colo., Ken Ritter and Michelle Rindels in Las Vegas, Laura Wides-Munoz in Miami and AP Deputy Director of Polling Jennifer Agiesta contributed to this report.

Sunday, July 22, 2012

Subversive Scripture?


The point that must be remembered is that most of political and church history has been controlled and written by people on the Right because they are normally the people in control. One of the few subversive texts in history, believe it or not, is the Bible. The Bible is a most extraordinary text because again and again it legitimates not the people on the top, but invariably the people on the bottom—from Abraham to Moses to Jeremiah to Job to John the Baptist to Jesus.

After a while you might get tired of the rejected son, the younger son, the barren woman, the sinner, the outsider always being the chosen one of God! It is the biblical pattern—which we prefer not to see. It takes away our power to exclude “the least of the brothers and sisters” because that is precisely where Jesus says he is to be found (Matthew 25:40)! If indeed women, blacks, other religions, gays, and other “outsiders” Lare “least” in our definition, it seems that gives them in fact a privileged and revelatory position! They are not to be excluded, but honored. Jesus takes away from us any possibility of creating any class system or any punitive notion of religion. Unfortunately, thus far, it has not worked very well.
from Richard Rohr
A Lever and a Place to Stand: The Contemplative Stance, the Active Prayer
pp. 98-99

Friday, July 20, 2012


A very small, "typical" (if such a denigrating term can be tolerated here) sparrow hopped into my pathway ths morning as I hurried up the rain-soaked sidewalk. Strange moment. The tiny winged creature worked hard at finding breakfast. I gathered coffee in an heroic effort to awaken to the day. The bird did the trick! Something about our dance captured my undivided attention. My little friend, clearly aware of me, stepped nearer into my path. For just a moment, a very clear moment, we both, aware of the other, greeted; extended greeting with presence and knowing connection. The delicate, brown creature moved toward me, no doubt to seize some falling crumb or seed, and I toward him to study the precise colors extending from his crown and down and across his feathery, mural-graced back. We stood in the same frame for but a breath, then moving on, having truly seen one another. Life, a sheer wonder every day.

Wednesday, July 18, 2012

More on Medicaid refusal: Questions for Governor Perry

Texans Need Real Solutions to Our Health Care

(AUSTIN, Texas)─The Center for Public Policy Priorities’ Associate Director Anne Dunkelberg released the following statement regarding the Governor’s announcement about Medicaid expansion and establishment of an insurance exchange as part of the Affordable Care Act.

“Expanding Medicaid is a great deal for Texas and refusing to do so is not something the Governor should decide by himself before Texans have had a full and thoughtful conversation about what's at stake for our state, and then the Legislature needs to decide on a course of action. Our state has an opportunity to help millions of Texans xget the quality, affordable health care they need, and we should not pass it up.

“Under the Medicaid expansion, the federal government will pick up the vast majority of the costs of helping as many as 2 million Texans who don’t have insurance get the health coverage they need. The federal government will cover 100 percent of the costs for the first three years of Texas’ expansion, and no less than 90 percent every year after that. The Texas Health and Human Services Commission has projected that even with a large enrollment increase in Medicaid for poor adults, our Medicaid costs would only increase by $5.8 billion from 2014-2019, and the state would receive $76.3 billion in federal matching funds—a net gain of $70 billion.

“Expanding Medicaid will save Texas money in other ways, especially by reducing the money it spends providing health care in emergency rooms and health clinics to people without insurance. Texas could even end up saving more on these costs than it spends on the expansion, easing the strain on property taxes.

“Failing to expand Medicaid would squander the opportunity to pump tens of billions of dollars into our state economy and leave as many as 1.5 to 2 million of struggling Texans out in the cold without insurance coverage. The last thing Texans want is to see our federal tax dollars pay for health care for people in New York or California rather than to cover people right here at home.

“Texas should also move forward with setting up a state-based health insurance marketplace, called an exchange, that will allow millions of Texans to use tax credits to purchase quality, affordable health coverage. As recently as 2011, a broad-based group of organizations including businesses, conservatives, and advocates all agreed that a state-based insurance exchange was a good idea for Texas. And the exchanges are where many of the Affordable Care Act’s most popular consumer protections are found, including the rule that insurers may not deny coverage to anyone with a pre-existing health condition like cancer, autism, or diabetes.

“Because one of every four Texans is uninsured, Texas has the most to gain from health care reform. Now more than ever, we need real solutions from our leaders that meet the health needs of all Texans.”

Tuesday, July 17, 2012

Unexpected guest!

I've said for years that if you live in Old East Dallas, you never know what to expect next! 

Of course, this is not our first encounter with "this element" of the population.  Last Halloween tricker-treaters spotted a group of this sort staring back at all of us from inside the window that lets light into our attic! 

Hey, you just never know!  But, at least everybody's welcome! 

Monday, July 16, 2012

CitySquare Community Health Services receives highest rating as "medical home"!

Great news for CitySquare's Community Health Services!  The National Committee for Quality Assurance, a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality recently released the results of the following practices as receiving the organization's highest quality ranking:

Baylor Family Medicine at Legacy
Family Medical Center at Terrell
Baylor Occupational and Family Health Center at TI
City Square
City Square- Pediatrics

Since 1997, our Community Health Services department has partnered with the Baylor Health Care System and Health Texas Provider Network to bring extremely high quality medical services to inner city Dallas.  The following letter tells the wonderful story:


We have not only completed the application process for NCQA Patient Centered Medical Home recognition for all of our adult, geriatric, residency and pediatric practices, but have now received the results. All practices received the highest possible level of recognition. Level 3 is the highest level for Electronic Health Record (EHR) practices and the highest for paper practices is Level 2. Out of a possible 100 points, our EHR clinics scored in the mid-90s on average. This means that we now have 60 practices, 271 physicians, and 59 non-physician providers (APRNs and PAs) in recognized medical homes. This is the second highest total of any system in the nation.

During this implementation and application process we have seen engagement in new discussions around topics like pre-visit planning, ambulatory care coordination, patient/family activation and patient access. More practices have extended hours than ever before. Heart failure readmissions have dropped significantly. Diabetes scores have improved. Guidelines have been standardized across our practices including many specialty practices. Insurers are coming to us asking for PCMH contracts that allow for new funded resources and opportunities for shared savings.

The journey started many years ago with the Quality committee's work on quality standards and measurement of preventive services and diabetes metrics. It continued with the work of the Service Excellence committee, the Ambulatory EHR committee, Patient Safety committee, Disease Management and EHR Content Committee, and then the PCMH Task Force. The medical home applications included work from all of these committees.

Join me in thanking the chairwomen/chairmen and members of these committees for their hard work as well Sarah Gahm and David Winter for their leadership. Of course we should especially thank Pat Link, the PCMH Director, and her team of consultants, writers and contributors: Endia Kendrick, Michell Martin, Niki Shah, Patrice McConnell, Ashley Wood, Vivian Plumlee, Joe Brumbelow, Nancy Trinh, Kelly Risinger, Beulah Casey, Cynthia Granade and Tim Houtchens. We also need to thank our physician auditor team who gave personal time to audit over 2,300 patient records, Drs. Hickl, Astbury, Aponte, Molen, Massey, Stroud, Thompson, Bassel, Berry, Caudill, Garcia, De Leon, Holbrook, McMillin and Sharp.

The journey of course never ends. We are already implementing the new PCMH criteria into our practices. Many of these are meaningful use criteria. We are also preparing to apply for NCQA recognition for our new practices under these new guidelines as well as preparing to support BQA non-HTPN practices.

We are blessed to have a group of physicians, nurse practitioners, physician assistants, administrators and staff who strive to provide safe, effective, efficient, equitable, timely and patient centered care. It makes our work more enjoyable and meaningful.

Thank You All,

Cliff Fullerton, M.D., M.Sc.
VP Chronic Disease Baylor Health Care System
Chief Quality Officer HTPN

What a privilege to be working in tandem with our partners at Baylor and Health Texas!  CitySquare continues to help provide the highest quality care possible to low income neighbors in the inner city of East and South Dallas. 

Way to go, CitySquare team!

Sunday, July 15, 2012

The daily play for hope. . .

Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current which can sweep down the mightiest walls of oppression and resistance.

Robert F. Kennedy

Friday, July 13, 2012


This has been a most challenging week for a number of reasons.  I'll not bore with details, except to say at times a person can wonder if there is any hope of real, sustainable, substantive progress. 

Then, things happen. 

Hope pops all around unexpectedly and in amazing, strange ways.

Mid-morning on Wednesday:  a young friend, brought to the US from Mexico as a child by his parents, literally against  his will--he was 12 at the time and his daddy made him come--drops in to see me.  I've known him for well over a decade.  So, this man is a classic for the DREAM Act--a child brought into the country as a minor by undocumented immigrants needing just relief so that he can stay here and put his good education to work. 

As he discusses the business that brought him to see me, he begins to reminisce.  He shares with me just how hard it was to leave Mexico, his grandmother, his cousins, his extended family.  He confesses the deep seated anger that he held inside against his father. In the midst of our talk he tells me that many of us at CitySquare stepped in and became "substitute" family. 

"You guys became my family, Larry," he spoke through free flowing tears.  "You took the place of my uncles, aunts, grandmother and cousins.  You shaped my life and helped me get beyond my anger." 

It was amazing catharsis for him and for me. 

As he spoke, a new understanding of the power and proficiency of community fell on my understanding of the importance of human connection and mutuality across silly, artificially imposed barriers. 

I was so glad that he came by.

Early afternoon Wednesday:  Janet Morrison appears at my door with a young man at her side.  She reminds me that he is Gustavo Vidal, one of "her kids."  Gustavo had come up through Janet's programming, first as a participant student and then as a helper with the other children. 

Several years earlier Gustavo had applied for and received a CitySquare scholarship award to help pay his expenses at the University of Texas in Austin.  He just graduated! 

Gustavo handed me a note that read:


I am writing to thank you for all the support that CitySquare has given to me since I was in elementary school.  Many of the education programs were extremely helpful in helping me take the steps I needed to take to attend college.  Words cannot describe how thankful I am for the time and resources that you made available to me.  I graduated this May with a degree in Government and with it I hope to be able to work in public policy.  Hopefully one day I will be able to help people in the same way you helped me.  Thank you.  Yours sincerely, Gustavo Vidal

Gustavo had returned to us to volunteer in our growing public policy work in the community. 

So much then for feeling hopeless!

Thursday, July 12, 2012



Rest is not idleness, and to lie sometimes on the grass under trees on a summer's day, listening to the murmur of the water, or watching the clouds float across the sky, is by no means a waste of time.

Sir J. Lubbock

Quoted at herondance.org

Wednesday, July 11, 2012

Texas Governor rejects Medicaid Expansion

Poor people don't do very well in Texas in any category.

Now comes the news that Texas Governor Rick Perry will reject federal funds to expand Medicaid to the very poor who remain uninsured.

Even more amazing is the fact that the federal government would pay 100% of the expansion costs for thre first three years and then 90% of the cost after that!

You'll be interested to hear the following report from NPR on the Governor's action. And, be sure and watch a FOX News interview with Mr. Perry here.


Tuesday, July 10, 2012

Sharks in the water!

Yesterday's editions of The Dallas Morning News published this opinion essay from the paper's editorial staff. It is gratifying to see the work of CitySquare's public policy team and those of our growing number of partners have good results in affecting public values and opinion. Much work remains to be done on the issue of predatory lending, but we're making progress! Thanks, Gerald and team for your hard work.

I've posted the editorial statement below.

Editorial: It’s time for tighter oversight of payday lenders

08 July 2012 10:38 PM

The free-enterprise advocate in us says that payday lenders should operate wherever the market takes them. It’s a business, after all. If people don’t want the product they sell, the market will show them the exit door.

The problem is that quick-cash lenders don’t operate under normal market conditions. Their market, in fact, operates exactly the opposite — enticing desperate people away from what should be their very first option, economizing in every way. When you are short on money, you buy cheaper food, find a lower-rent apartment.

Banks make their services scarce for people in trouble. There’s no cheap, off-brand place to shop. For many consumers, the only choice is to seek out a title lender, who will accept a car or house title as collateral on a short-term, high-interest loan. Like a shark hunting wounded prey, the companies profit by exploiting the customer at his weakest moment.

Texas, which has some of the loosest regulations in the country for payday and title lenders, is witnessing an explosive expansion of these businesses. Oversight is nowhere near what it should be as some lenders charge usurious amounts. Effective rates of 300 percent or more are common, and when the customer can’t pay, his car or house becomes the lender’s property.

In a recent study by Texas Appleseed and the Anti-Poverty Coalition of Greater Dallas, 37 of the 241 short-term lenders in the city were surveyed on their effective rates and the legally required loan information they make available to clients. As Gerald Britt Jr., vice president of public policy at CitySquare, noted on our Viewpoints page last week, 41 percent of outlets surveyed did not abide by legal requirements and offered misleading information about the risks of quick-cash loans.

They get away with it because lawmakers who seek tighter oversight run into an extremely well-funded lobby. Quick-cash lenders donate heavily to politicians and intimidate city governments with the threat of expensive litigation.

Fort Worth-based title lender Cash America International is the No. 1 contributor to Dallas GOP Rep. Pete Sessions. Rep. Jeb Hensarling, R-Dallas, ranks No. 10 in the House for contributions from the payday loan lobby, according to OpenSecrets.org.

The industry donates generously to Democratic and Republican legislators alike at the state level. Dallas Mayor Mike Rawlings previously sat on the board of directors of Ace Cash Express and has defended such services as necessary, particularly in southern Dallas, to serve the “under-banked.”

What about protecting the over-exploited? As this newspaper noted in a Points special section last October, there is a lopsided presence of quick-cash loan shops in the poorest neighborhoods of southern Dallas and an unusually strong concentration of these loan shops in Dallas’ biggest crime hot spots — both north and south. We do not need more of them.

If legislators won't to stand up to this powerful lobby, reject their donations and impose tougher regulations, the least Dallas and other local governments can do is ensure that existing laws are enforced vigorously.

Stop treating the financially vulnerable as shark bait.

Follow the money

A sampling of campaign donations by members of the quick-cash loan industry from 2008 to present:

Recipient / Donor / Amount

Rep. Pete Sessions, R / Cash America Int’l / $37,500

Rep. Jeb Hensarling, R / Cash America Int’l / $24,500

State Rep. Helen Giddings, D / Cash America Int’l / $5,750

State Sen. Royce West, D / Cash America Int’l / $5,000

State Rep. Raphael Anchía, D / Cash America Int’l / $3,500

State Rep. Marc Veasey, D / Cash America Int’l / $2,500

Texans for Joe Straus / Ace Cash Express / $34,000

Texans for Rick Perry / Ace Cash Express / $22,000

Mexican-American Legislative Caucus / Consumer Service Alliance of Texas* / $20,000

Texans for Greg Abbott / Ace Cash Express / $12,500

SOURCES: Federal Election Commission, Texas Ethics Commission

Sunday, July 08, 2012

Listening our way to love

Listening and Love

We can love only those human beings to whom we listen, and love is the heart of the spiritual way.

No one can ever learn to listen to God who has not first learned to listen to human beings.

The one who cannot listen cannot love either another or God.

Morton Kelsey
Through Defeat to Victory

Saturday, July 07, 2012

RIP, Andy

I grew up on Andy Griffith right in the middle of Mayberry, USA. My hometown was so much like Mayberry that I've always believed that sleepy little place reflected much of what our community building work in the inner city aimed to achieve, but with a lot more cultural and ethnic diversity. So, I post my favorite episode of The Andy Griffith Show in memory of Andy who passed away earlier
this week.


Friday, July 06, 2012

Housing First

The following report appeared in the Sunday, July 1, 2012 edition of The Dallas Morning News. "Housing first" and the work of CitySquare's Homeless Outreach Team is the focus. Not mentioned in the report are the details of a very creative, innovative alliance that involves Downtown Dallas, Inc. and CitySquare's Social Work Services department and our AmeriCorps team. Lots to think about here. As always, I'm eager to read your reactions!

Housing first, treatment later: Dallas homeless agencies experiment with new approach


Grant Wells often wakes up on the back porch of his social worker’s house in East Dallas, having slept off a half-liter of vodka.

He is among the hardest of the hard-core homeless, an alcoholic who has been on the streets 20 years. And soon, he’ll move into his own, publicly subsidized apartment, without any prior obligation to get counseling or quit drinking. “We want to get him a home that’s near the bar,” said the social worker, Jonathan Grace, who has been on the case eight months. “It sounds strange, but that’s his comfort zone and those people there are his support system.” Wells is being placed through a method called “housing first,” in which people are moved directly from the streets into homes.

Advocates argue that housing is a basic human right — not a reward for getting sober. Critics say it’s unfair to charge people with the responsibility of caring for their own homes before helping them overcome demons such as alcohol and drug abuse. Several studies done in Seattle, New York and Denver showed the method ultimately saved taxpayers money by cutting the amount of emergency and legal services needed to care for the homeless. According to a study published in the Journal of the American Medical Association, the Seattle participants in a housing-first program cost taxpayers more than $4,000 a month. After six months in a housing-first program, the 95 participants cost an average of $1,500 monthly. After a year, they cost about $950 per month. The researchers showed costs eventually dropped off the longer participants stayed in permanent housing — and took advantage of support services.

The approach has been adopted by several local advocacy groups for the homeless, but others remain unconvinced, saying they don’t have enough caseworkers to constantly monitor a population placed in housing before treatment. “I can’t get too excited about the idea,” said Liam Mulvaney, president and chief executive of LifeNet, a nonprofit that provides supportive housing for those who suffer from mental illness. He acknowledged that the housing-first approach works in Seattle and Los Angeles, but he says that’s because those cities have more resources. “If we constantly have to deal with someone being drunk or smoking pot or hearing voices, it’s distracting,” Mulvaney said. “That doesn’t seem like the best use of our already scarce resources.”

‘Washing Christ’s feet’

Wells, 59, and his caseworker make an unlikely pair: Grace, with long hair and a love for heavy metal; Wells, a homeless former Marine. Grace’s employer, the nonprofit group CitySquare, took on Wells’ case after watching him fish through trash bins in Deep Ellum for meals. Wells hasn’t read the research on housing first. He’s unaware of the method, other than it’ll help him settle into a home. Until then, he often finds a bed on Grace’s porch, usually barefoot after losing his shoes. Grace doesn’t seem to mind. He drags Wells inside to clean him up for his next appointment at the Veterans Affairs office, washing his bruised and battered feet.

“It’s the closest I’ll come to washing Christ’s feet,” Grace said. “It’s this disgusting, humbling thing. But I realize taking care of Grant is not a chore. It’s a blessing. “There shouldn’t be any degradation,” Grace said. “They are our neighbors and our friends.”

Wells could be just days away from moving into his new apartment through the Housing First Program with Veterans Affairs of North Texas. After that, according to the plan, he’ll get treatment to wean him from vodka. No matter how long that takes, he will have a home, said Teresa House-Hatfield, director of the Comprehensive Homeless Center at the Dallas VA Medical Center.

Nontraditional model

The housing-first approach was developed by New York researchers and social workers in the 1990s to target mentally ill and chronically homeless people. Since then, several nonprofits have adopted the method across the country, from New York to Los Angeles. In traditional models, the homeless are moved from the streets to shelters, shelters to transitional housing, and, finally, into permanent housing.

The Department of Housing and Urban Development allocated $1.5 billion in grants for a three-year program to end homelessness through prevention and “rapid re-housing.” They called housing-first methods among the best for communities to end homelessness.

“We have to find ways to have less transition time before permanence,” said Mike Faenza, president and chief executive of the Metro Dallas Homeless Alliance. “The value in this is people are best served when they are secure, when they are in permanent housing.” A few organizations have adopted variations of housing first, including Metrocare Services in 2006. The VA first received funding for its program late last year, but started providing vouchers about a month ago.

In the spring, a housing campaign called 100,000 Homes linked several local homeless advocacy groups to identify some of those “vulnerable” homeless men and women who would benefit from housing first. The groups went to homeless encampments to find those who refuse shelter and treatment.

Advocates and social workers such as Grace have worked to connect those hard-core homeless to the VA or other nonprofits, some of which use housing first as a method. House-Hatfield said about 50 out of the 740 housing vouchers issued by the Dallas VA are going toward housing-first approaches. Most of the men and women who are part of the effort were using no veterans’ services or benefits previously.

“If you think about it, it makes all kinds of sense,” said Larry James, president of CitySquare. “How do you get control of your life if you’re still on the street? You spend so much of your time and energy figuring out where you can sit and where you can eat.”

Wells agreed. Giving up drinking while sleeping on the streets “doesn’t seem to work,” he said. In exchange for his housing, he’ll sign a lease and prove that he is chronically homeless and agree to weekly visit from social workers or nurses. Wells also will pay a maximum 30 percent of his monthly income for the apartment, or at least $50 a month. The rest will be covered by the Dallas Housing Authority. The staff of counselors and nurses cannot discharge veterans if they relapse, though veterans involved in illegal activity can face consequences with police or landlords.

“We continue to work with them despite their use or relapse,” House-Hatfield said. “Even if they fail to be successful at one apartment location, it doesn’t mean we’d give up on them. As long as they’d be willing to try.”

Different approaches

At other agencies, the approach remains traditional. At The Bridge, the city’s downtown homeless assistance center, social workers continue to use a recovery-based approach. Someone who walks into The Bridge isn’t given a set of keys. “It could take two months or it can take two years,” said Jay Dunn, president of The Bridge.

The homeless are given support to deal with mental illness, addictions and legal issues before they are eligible for housing. And once they do get permanent housing, data show a 90 percent rate of success.

“There isn’t a competition between the two approaches,” Dunn said, referring to housing models for the homeless. “I think we need all of these approaches for different people.”

AT A GLANCE: A picture of the homeless in Dallas

The Metro Dallas Homeless Alliance conducts an annual census of the homeless population. The most recent count found:
• 407 individuals classified as “chronically homeless,” meaning they’ve been on the streets longer than one year and have a disability.
• 3,447 total individuals who were homeless.
• 496 adults who responded to surveys said they had children living with them on the night of the count.
• 8 families counted were identified as “chronically homeless” and include a parent with a disability. • 25 percent of those surveyed reported becoming homeless in the past year.

ANOTHER LOOK: Cheaper alternative

A recent study of the cost of caring for the homeless in Dallas found:
• It costs an average of about $39,000 annually to care for homeless individuals who require the most attention. That includes emergency treatment and trips to jail.
• A person can be housed and treated for $15,000 a year under housing-first methods.

Thursday, July 05, 2012

Poverty. . .

I’ve lived in the inner city for almost 14 years.  As a result, poverty is no longer an abstraction for me. 

Poverty feels like a crushing weight. 

Poverty inspires fear. 

Poverty gets personal real fast. 

Poverty sucks the life out of a person one day, one hour, one block at a time. 

Poverty is contagious. 

Like a cancer, poverty can grow wildly, quickly. 

Poverty leads to death, death of hope and spirit. 

Poverty is anti-family. 

Poverty humiliates. 

Poverty breeds hopelessness.

Poverty is unjust—you’ll find no fairness underneath the surface of poverty. 

Poverty inflicts cruelty. 

Poverty is inhumane. 

Poverty wrecks lives here and now. 

Poverty leads the way to generations of suffering and defeat. 
My faith tells me. . .

. . . my experience tells me,

. . . my friendships tell me,

. . . my abundance tells me,

. . . my heart tells me that poverty must not go unchallenged. 

If I am a human being made in God’s image, I must respond to the terrible reality of poverty and the suffering it inflicts. 

Working among the poor is a war. 

Not everyone can be here. 

We are. 

We need your help in the battle that rages around us every day. 

It’s real simple. 

Will you help us today? 

Wednesday, July 04, 2012

Freedom for all. . .

Roger Williams, the founder of Rhode Island and thorn in the side of the Plymouth Colony leadership, captured my imagination even as a young, junior high school student of American history. 

Arriving in Boston in 1631, Williams quickly found himself at cross purposes with peers from Plymouth (Massachusetts) as he defended a radical vision of freedom of religion and separation of church and state over a century before Jefferson drafted the Declaration of Independence and later the colonial leaders adopted the Constitution. 

Williams, a Baptist, embraced a radical vision of the proper relationship between faith and the state.  His life's work promoted their complete separation in an era when, even in the colonies, religion remained "established" or officially supported by the state, as in England.  Williams resisted the idea of the establishment of religion and formed his settlement that later became Rhode Island on this fundamental premise. 

In addition, Williams established good relations with Native Americans who assisted him in finding a settlement that afforded protection for his mission.  Not surprisingly, Williams opposed slavery and worked to block its entrance into Rhode Island. 

One of my favorite school book images is that of Williams making a 100+ mile trek through a blizzard in the wilderness on his way out of Plymouth toward the land that would become his colony as he escaped persecution for his ideas. 

Roger Williams' quotes on freedom and faith:

"Enforced uniformity confounds civil and religious liberty and denies the principle of Christianity and civility.  No man shall be required to worship or maintain a worship against his will."

"That cannot be a true religion which needs carnal weapons to uphold it." 

"By concord little things grow great, by discord the greatest come to nothing."

Sunday, July 01, 2012

God believes in entitlements and rights. . .

"Speak out for those who cannot speak, for the rights of the destitute. Speak out, judge righteously, defend the rights of the poor and needy."

- Proverbs 31:8-9