Lessons from History on "Integrated Service Delivery": A Primer
EDITOR'S NOTE: This blog post is the second in a series from Anne Guthrie, Graduate Intern for Savings & Financial Security. It's a great read for anyone wanting a quick but comprehensive overview of the history of integrated service delivery.
"Integrated service delivery" is one of the most popular topics in the asset-development field. What was once a jargon-laden term confined to public administrative journals is now widely used in describing a particular asset-building model that has gone to scale over the last five years. This model was first piloted by the Annie E. Casey Foundation when it launched its Centers for Working Families (CWF) in 2004. The CWF model integrates employment, income supports and financial services to address the multiple and complex needs low-income families have in reaching long-term financial stability.
A record number of nonprofit organizations have embraced the CWF approach. There are now Financial Opportunity Centers, Spark Point Centers, Prosperity Centers, Financial Empowerment Centers and others—each may have a different name and variations on the model, but all embrace the core strategy of integrating workforce and asset-based services. Just last year, the Working Families Success Network was formed to build the capacity for what is now known as the "Integrated Service Delivery" (ISD) model. This network collectively invests and delivers the ISD model in over 155 locations in more than 30 cities in 12 states around the country.
With excitement surrounding the ISD model, I found it interesting that "integrated service delivery" is not a new concept. It has been recognized since the beginning of settlement houses in the early 1900s, where government and nonprofit organizations offered autonomous programs that enabled a family's ability to receive all the supports necessary to escape poverty. A prime example is Jane Addams' Hull House, which offered housing, health, employment, child care and household money management activities under one roof.
Of course, you can see the roots of integration at the policy level starting with the War on Poverty in the 1960s, where neighborhood centers coordinated a range of services that targeted specific low-income neighborhoods. However, it was not until 1972 that the term "integrated service delivery" was born thanks to the Department of Health, Education and Welfare's (HEW) Service Integration Targets of Opportunity (SITO) projects and Partnership Grants Program. At this time, HEW estimated that that 85% of clients needed more than one service, but only 20% who were referred to other resources were able to connect.1 Here's another mind-blowing fact: when a mother visited the welfare office, her needs required the response of 15 separate public and nonprofit organizations.2
This first wave of integration aimed at consolidating major departments to offer integrated programs under one umbrella. However, many services remained fragmented, and the administrative integration failed to translate into an increased number of families enrolled in more than one service.3 In 1984, Congress initiated a new program, the Services Integration Pilot Projects, and the National Center for Service Integration was established. This second wave of integration efforts focused more on the operational mechanics in designing service flows and training staff to enroll clients in multiple services. This philosophy eventually led to the "One-Stop Centers" in the late 1990s that consolidated separately funded programs to provide a full range of services to job seekers under one roof.4
The service integration movement resulted in cross-agency planning, increased caseworker communication, a wider referral network, linkages to community colleges and the convenience of services located in one center. However, multiple studies found that the majority of departments in "one-stops" still had a ways to go in being truly integrated. While departments were consolidated and services were under one roof, the majority of programs remained confined by their individual funding streams with separate goals and performance standards. Service integration also takes a considerable amount of time and effort to maintain. Without strong leadership behind the model, caseworkers passively refer to one another, and clients remain confused in a sea of disjointed programs. Thus, programs were better coordinated, but not all were integrated to ensure clients were active and supported in more than one service.5 6
This next wave of integrated service delivery through the Working Families Success Network and other organizations operating the ISD model will continue to build upon this history and move the needle towards understanding true integration. Not only will the ISD model continue to help the field understand the factors the lead to successful integration, but it has broadened the concept to include the integration of asset-building and financial coaching services. Up until this point, the history of integrated services has primarily concentrated on income-based services (e.g., employment, education, training, income supports). This shows that it is not only about integration, but integrating the right services, and that including a coach, or someone by a family's side, may be crucial in helping low-income families navigate multiple services and reach financial stability.
1 Waldfogel, J. (1997). The New Wage of Service Integration. Social Service Review, 71(3), 463-484. 2 Agranoff, R. (1991). Human Services Integration: Past and Present Challenges in Public Administration. 51(6), 533-542. 3 Voydanoff, P. (1995). A Family Perspective on Services Integration. Family Relations, 44(1), 63-68. 4 Agranoff, R. (1991). Human Services Integration: Past and Present Challenges in Public Administration. 51(6), 533-542. 5 Ragan, M. (2003). Building Better Human Service System: Integrated Services for Income Support and Related Programs. Albany, NY: The Nelson A. Rockefeller Institute of Government. 6 Pindus, N., et al. (2000). Coordination and Integration of Welfare and Workforce Development Systems. Washington, DC: The Urban Institute.