Human Services Systems Integration: a Conceptual Framework

It is generally believed that the existing human services structure is most accurately described as an array of potentially related programs that deliver distinct benefits or services to narrowly defined target populations. Each program can be thought of as representing a service silo: a separate and distinct funnel through which money, regulations, and professional norms, and expectations flow. While some overlap across silos has always existed, each usually operates in a relatively self-contained manner. As a whole, the configuration of services available to support and assist families in their efforts to become self-sufficient can be complex, confusing, redundant, and incoherent. The opposite of this silo-based approach to organizing and delivering human services is often coined ‘systems integration.’ What exactly is systems integration? Building on lessons learned from the field, the authors conclude that, although it is not possible to create one all-encompassing definition of ‘service integration,’ it is possible to develop an overarching, conceptual framework for understanding and analyzing the essential process involved in such efforts to simplify and transform the service experience of target populations. This paper identifies the heterogeneity that exists across these efforts and from it develops a set of organizing principles and constructs for planning a service integration initiative. First, it elaborates on two key dimensions—relationship intensity and institutional similarity—critical for understanding any particular integration effort. Second, it proposes a strategy for framing integration efforts based on these two dimensions. Third, it considers the implications of this framework for developing an integration agenda. Finally, it identifies the basic components of all integration efforts within the context of a dynamic, rather than static, operating environment. It is generally believed that the existing human services structure is most accurately described as an array of potentially related programs that deliver distinct benefits or services to narrowly defined target populations. Each program can be thought of as representing a service silo: a separate and distinct funnel through which money, regulations, and professional norms and expectations flow. While some overlap across silos has always historically existed, each usually operates in a relatively self-contained manner. As a whole, the configuration of services available to support and assist families in their efforts to become functioning and self-sufficient members of society can be complex, confusing, redundant, and incoherent. The opposite of this silo-based approach to organizing and delivering human services is often coined ‘service integration.’ But, what exactly is ‘service integration’? Would we recognize an integrated system when we saw one? How would we describe it to others? Would we know if we were moving in the right direction as changes are being introduced? What would we tell others if they asked what we wanted to achieve and why they should support such a vision of reform? These are not trivial or irrelevant concerns. If we cannot articulate what we want to achieve, then we probably do not know what it is. And if we do not know what we are pursuing, success is likely to prove elusive. Unfortunately, a ready-made definition of service integration does not exist. We have not been able to find a magic threshold that marks the separation of unintegrated service systems from those we would characterize as integrated. This is a bit surprising, given that there are numerous local and state experiments and pilots in operation. Mark Ragan, drawing on extensive field-work completed on behalf of the Rockefeller Institute for Government, concluded that no such ‘off-the-shelf’ definition exists. There is no single answer. Based on observations...service integration is a combination of strategies that simplifies and facilitates clients’ access to benefits and services. Each site has implemented a distinctive mix of strategies, processes, and partner agencies. We arrive at a similar conclusion based on our own fieldwork. Currently, many different initiatives being pursued around the country under the rubric of service integration. These initiatives focus on different populations of interest, pursue distinct reform strategies, encompass a variety of institutional partners, and envision unique purposes. Yet, they are all considered service integration reforms by their sponsors. Some of the ways these pilot programs differ include the following: • Tactics—Some involve large one-stop centers, others virtual networks or agreements to work together while maintaining physical separation and distinct management structures, and still others hire someone to ‘broker’ services for program participants. • Scope—Some are organized around bringing together programs and services that share common purposes (e.g., providing income support) while others blend systems with 1 This issue has been discussed in other publications. One organization that has drawn attention to it is the Midwest Welfare Peer Assistance Network (WELPAN), a group of high-level welfare officials from Indiana, Illinois, Iowa, Michigan, Minnesota, Ohio, and Wisconsin who convene regularly to discuss common challenges and solutions faced in administering their welfare reform and related programs. See, in particular, WELPAN (2002). Eliminating the silos: Or, it’s not just welfare anymore, Institute for Research on Poverty: University of Wisconsin-Madison. 2 Ragan, M. (2003). Building comprehensive human service systems. Focus 22(3), 58-62. Mark Ragan and the authors independently spent time in several sites, including Kenosha and Racine, Wisconsin; El Paso County, Colorado; Montgomery County, Ohio; Anoka County, Minnesota; and San Mateo County, California.