Integrated Social Services: Let's Gather Evidence of What Works and Why

Feb 21, 2019

Imagine that your family has fallen on hard times. Your husband was injured on the job, can’t work, and is still waiting for his disability insurance to kick in. You’ve stayed at home to take care of your kids, including one who has special needs. You’ve exhausted your savings, and you made the difficult decision to apply for public benefits while you gain some skills to go out on the job market.

You don’t know where to start. You go online, but you can only find basic information. You show up to an employment center, but they don’t know much about cash assistance, so they refer you to a different office a few miles away. When you arrive there, you’re confronted with a stack of forms to fill out and asked to prove your lack of income—information that you will now need to go back home to collect. You need to separately apply for cash assistance, federal nutrition benefits, and subsidized child care for your youngest all while you pursue employment.

Meanwhile, you’re filling out forms asking for essentially the same information over and over again, explaining your situation to a half dozen staff in different agencies, and getting more and more frustrated.

One of the problems families in crisis often encounter is a decentralized social services system made up of silos organized by agency and program, not by the customer experience. Of course, conversations about integrating service delivery across social services—workforce development, cash assistance, nutrition benefits, Medicaid, and others—have been taking place for decades. Some progress has been made, but we remain far away from meaningful integration in most parts of the country. It’s easier to find examples of integration in name only—states creating an umbrella agency or co-locating social services in the same physical location but not going the additional step of integrating their eligibility documents, staff, or data systems. Today, many states have either streamlined or combined applications for people who are eligible for certain programs, such as Medicaid and nutrition assistance, but not for the full range of programs and services that would support the whole family. Some places, such as Montgomery County, Maryland, are taking the additional step of integrating their electronic case management systems so that health and human services staff can store records and track outcomes for the same client across different programs. But these promising efforts remain the exception to the rule.

It’s not just frustrating for the people who receive social services—it’s also frustrating for the well-meaning staff who are trying to help them. Those staff have to collect, sort, and enter all that paperwork into multiple data systems. Many of them are entering information that can already be found in another data system, but it doesn’t matter because the systems don’t talk to one another.

Now imagine a different world in which people who need social services could go to their neighborhood community centers, complete a few forms, and work with one person to develop a plan to access all the services they need: cash assistance, nutrition benefits, Medicaid, employment services, behavioral health services, and child care. Integrating service delivery across social services could accomplish that. It could be a win-win, providing a more seamless and higher quality experience for customers and reducing administrative time and effort for social service providers.

Why hasn’t this different world emerged?

One reason that social services haven’t seen more integration yet is the concern about protecting customers’ privacy while sharing their data across programs and agencies. Data-use agreements can take years to develop and run dozens to hundreds of pages long. This is a challenge that individual public agencies with limited budgets are not in a strong position to address on their own.

Another key challenge is getting all the stakeholders to buy in. Particularly in public agency settings, administrators and staff are so consumed by running their day-to-day operations that it can be tough to slow down and plan for the long-term investments necessary to increase operational efficiency and streamline the customer service experience. In some cases, the dollar amount of these investments is small, but the staff time investment can be considerable.

So what can we do to overcome these challenges?

Demonstrating successes and making the business case is key to gaining the buy-in and will of stakeholders to pursue meaningful service integration. For example, an agency could develop a pilot program for a few related services in a limited geographic area. Part of the pilot could include documenting cost savings, increases in client satisfaction, and improvements in client outcomes relative to pre-pilot circumstances. With proof of concept in hand for social service integration, the pilots could be expanded and a rigorous evaluation added to determine whether the goal of sustained benefits to disadvantaged citizens and taxpayers is realized at scale.

Agencies have other options as well. They can bring together stakeholders across agencies, identify their goals and objectives, and demonstrate how to achieve those goals and objectives through collaboration. Part of that collaboration would entail agreeing on common outcomes across agencies and programs and developing a universal data-use agreement for all relevant agencies. Again, these changes can be tested for effectiveness.

Clearly the challenges are substantial, and the path forward would require time and resources. But the operational efficiencies and benefits to social service clients might be worth it. Anything short of our best effort to find out—through shrewd and ambitious reform strategies and careful research—would fail the system and the economically stressed Americans who depend on it.

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The opinions expressed on the Evidence in Action blog are those of the author(s).