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increase in housing costs and a decrease in programming budgets. Public transportation limits appear to be a significant barrier to residents seeking services, as does an increase in ethnic diversity and linguistic isolation. An increase in homelessness has amplified the demand for an already insufficient stock of affordable housing, housing options and services. There is a clear lack of sufficient behavioral health services in the Tri-Valley and insufficient workforce development opportunities, particularly for women, seniors, youth and the disabled. There is also insufficient affordable afterschool and summer programming to support the social development of the community's children and youth. Two significant hurdles relate to the lack of knowledge of available services and geographic isolation making it difficult for some to physically access the resources that they are aware of. Those polled indicated a strong need for dental care, primary health care, food and nutrition, job training, and transportation. They cited the cost of transportation, lack of qualification, and lack of time as the most predominant barriers to obtaining service. Social service providers also recognized lack of knowledge about available services and transportation issues as significant barriers. Increased funding, provider coordination, community outreach, and transportation were seen as critical to providing more services. Ms. Suskin reported on the assessment's recommendations, which include development of a strategic plan; collaboration between the three cities to prioritize the issues, identify resources, and develop objectives; increased collaboration across systems; increased outreach to underserved communities using cultural brokers, health fairs, and back to school events; and newcomer leadership programming. Mayor Hosterman said she was struck most by the need for dental care. She asked if the concern spans all age groups and whether it is due primarily to a lack of available care, affordable care, or adequate transportation. Ms. Suskin said that the need for specialty care, particularly amongst low- income seniors, appeared to be incredibly challenging. This appears to be due to an insufficient number of professionals in the area serving people with subsidies which require them to travel far outside of the community to secure care. In terms of age demographics, she explained that data was not specifically disaggregated by age. Peter Neely, RDA Consultants, pointed to the significant cuts in MediCal subsidies for dental care. Councilmember Sullivan asked if a lack of health insurance appeared to present a significant hurdle. Mr. Neely said little information was received regarding those without coverage. However, those who do have coverage through MediCal or Medicare reported long wait times or delays in being able to schedule care. Mayor Hosterman said that between Axis Healthcare and the public transit system, she was under the impression the City was doing fairly well. She inquired about the discrepancy between this and the apparent need. Ms. Suskin said that Axis Healthcare was reported to be a positive program overall, although significant wait times did appear to be an issue. RDA heard a particular need for specialty healthcare (particularly mental health) which appeared to be more of a critical issue than primary care. Those in need were routinely required to travel outside of the local area, which led to difficulty in and perhaps an inability to Axis those services. Commissioner Nagler said that low-income providers, including Axis Healthcare, reported real difficulties in preserving services in the face of reduced reimbursement rates from the state. Vice-Mayor Cook-Kallio asked whether the paperwork and completion of forms appeared to be an impediment for either native or non-native English speakers. Ms. Suskin referred to the report for more information on linguistic isolation as an indicator of those challenges. She also reported difficulty from those with sensory and cognitive disabilities. Commissioner Berger noted that many agencies have someone available to facilitate the completion of various MediCal forms, as that is part of how they receive reimbursement. The issue of dental care, Special City Council Minutes Page 2 of 5 January 24, 2012