Services Integration: A Twenty-Year Retrospective

Purpose

In the 1970's and 1980's, the Department of Health, Education, and Welfare (HEW) and its successor, the Department of Health and Human Services (HHS), have taken many initiatives to promote a more integrated management and delivery of human services. In this study, we examine those initiatives to identify major lessons learned that can help guide policymakers in the 1990's. In so doing, we pay particular attention to comprehensive initiatives which have spanned different categorical programs.

Background

Services integration (SI) is a response to the highly fragmented nature of the human services environment. It involves effons at service delivery and administrative levels to establish linkages that contribute to the effectiveness, efficiency, and economy of human services programs. Over the past two decades, there has emerged a considerable body of .literature that describes and assesses these SI efforts. In this report, we base our findings and concluding observations on a review of much of that literature and many internal HEW/HHS documents, companion report, "Services Integration for Families and Children in Crisis (OEI-09-90-00890), identifies and analyzes 13 SI efforts initiated at the community level to assist dysfunctional or multiproblem children and families.

Findings

SI efforts have been instrumental in making human services more accessible to clients and more responsive to their needs. Over the long term, however, SI efforts appear to have had little institutional impact on a highly fragmented human services system. SI efforts that cut across program areas confront fundamental barriers. They include:

1. Size and complexity of the human services system.
2. Professionalization, specialization, and bureaucratization.
3. Limited influence of integrators,
4. Weak constituency for services integration.
5. Funding limitations.
6. Insufficient knowledge.

Principles for Future SI Efforts

Given the enormity of the barriers they face, Sf efforts that call for major institutional reform should be initiated selectively, if at all.

An Sf strategy likely to generate more near-term success is to focus on well-defined target groups and to pursue reform primarily within categorical program areas.

Even a target-group, categorical-program approach, however, is likely to require some degree of central authority and flexible funding to generate and sustain more integrated service delivery.

A funding source granting an organization some authority and flexible funding for promoting Sf should hold it accountable for defining and measuring expected outcomes.

The cultivation and maintenance of networks of individuals engaged in Sf efforts is vital to the success of these efforts.

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