OVERVIEW
Human services have an opportunity to build and enhance people’s strengths and resilience by shifting services from responding to crises like eviction to preventing these crises by reducing risk factors, promoting protective factors, and creating the safety and stability needed to avoid adverse experiences that can escalate into crises (Akers et al 2023). Integrating programs and services is central to creating a proactive and supportive human services system. When services are compartmentalized, it can be easy to overlook risk factors beyond the purview of those services, and systems may focus on promoting specific services instead of lifting up the strengths and needs of the individuals and families they serve. Integrating services enables service providers to focus on early identification and anticipation of needs for individuals and families so they can receive support before they are in crisis. Service integration can also help reduce service silos that burden individuals and families with duplicative and inefficient eligibility determinations, enrollment processes, service provision, and communication between individuals or families and staff (Cavadel et al 2022). This experience can discourage individuals and families from engaging in services that can build their capacities to achieve their goals (Akers et al. 2023). Other research has suggested that centralizing services may result in more efficient allocation of resources.
This brief summarizes case study findings from nine sites that integrate human services with a prevention lens . The study specifically focused on approaches for preventing involvement in the child welfare system, promoting housing stability and preventing homelessness for youth and families, and increasing the use of economic supports such as Temporary Assistance for Needy Families (TANF).
Five sites were led by state or territory agencies or offices including Georgia, Maryland, Ohio, Oregon, and Washington, DC. All of these sites partnered with community organizations and local partners to deliver services. Three sites operated locally, including Cook Inlet Tribal Council, IMPACT Partnership, and Maine Foster Youth to Independence. The Foster Youth to Independence initiative is a competitive grant program run by the U.S. Department of Housing and Urban Development. The program enables public housing authorities to provide Housing Choice Voucher assistance to youth between 18 and 24 years of age who are or have aged out of foster care. Under the Foster Youth to Independence program, public housing authorities partner with public child welfare agencies. The Maine Foster Youth to Independence program is administered by the Maine Department of Health and Human Services and the Portland Housing Authority. Vermont Parent Child Center Network is a statewide network of community-based organizations that worked in close collaboration with a state agency. Five sites provided services to families with low income or young children; one provided services to the general population; one provided services for individuals with mental health and substance use disorders; one provided services to Alaska Native populations; and one provided services to youth aging out of foster care.
Case study sites served a wide range of families with different levels of involvement in systems and risk factors (Table 1). To meet the needs of those families, case study sites provided a mix of primary, secondary, and tertiary prevention. All sites provided multiple types. For example, the Ohio Children’s Trust Fund engaged in primary, secondary, and tertiary prevention strategies. The initiative offered an online parenting program to everyone in the state (primary prevention) and also worked directly with child welfare agencies in seven counties to refer families to the program with unsubstantiated allegations (secondary prevention) and open child welfare cases (tertiary prevention).
HOW DID CASE STUDY SITES INTEGRATE SERVICES WITH A PREVENTION LENS?
Sites described how integrated and streamlined services could support prevention of deeper system involvement and conditions associated with continued system involvement. Sites designed strategies to simplify access to services and first meet immediate needs through a “no-wrong-door approach” where agencies collaborate to connect families to the services they need, no matter which agency they initially contacted. In some cases, the no-wrongdoor approach was operationalized by offering services at a centralized location. Sites also prioritized offering stabilization services and employed case management and navigation approaches.
Sites helped participants access multiple services through a flexible ‘no-wrong-door’ approach, often with services co-located in one location. Staff at six sites said that centralizing integrated services in one location – a “one-stop shop” – was important to reduce barriers to services and meet families’ needs. Parent Child Centers that are part of the Vermont Parent Child Center Network served as service hubs for early childhood and family services in sparsely populated, rural communities. Where needed, they provided transportation to bring families to the centers. Cook Inlet Tribal Council, a nonprofit organization with tribal authority serving American Indian and Alaska Native people residing in the Cook Inlet region of south-central Alaska, employed a single access point (a no-wrong-door approach) by using a common assessment during intake to improve participants’ access to services and minimize the burden of providing the same information multiple times to determine eligibility. With the common assessment, Cook Inlet Tribal Council participants could gain access to any of the organization’s offerings regardless of their initial reason for seeking help.
Sites prioritized services that would meet immediate needs to help stabilize the individual or family. Sites reported that it was common for families to have “immediate needs” and that it was important to address these swiftly to avoid deeper system involvement. For example, the Oregon Department of Human Services’ Family Support and Connections program, which offered free, voluntary services to help reduce parents’ stress associated with emergent needs, provided preloaded debit cards to participants to pay for rent and utilities. By supporting the immediate stabilization of these families, staff believed these short-term supports reduced the likelihood of future challenges or system involvement. Providing diapers, for example, could reduce the likelihood of someone making a report of neglect to the child welfare system. The Maine Foster Youth to Independence initiative is a collaboration between the Maine Department of Health and Human Services and the Portland Housing Authority that connects young adults who have recently aged out of foster care and are at risk of homelessness to stable housing and supportive services. Their staff said they had funding available for participants in “survival mode” who need help meeting their day-to-day needs like meals. The Ohio Children’s Trust Fund, which provided the evidence-based home visiting program Positive Parenting Program Plus (Triple P+) throughout Ohio, gave some participants a one time payment of $500 to help address immediate needs or crises, such as eviction, unpaid bills, healthcare needs, or groceries.
Case management and navigation services enabled sites to build trust and reflected a person-centered approach. Six sites used case management or navigation services to work in partnership with families and individuals. These sites described developing trusting relationships that supported individuals and families in setting and achieving goals while identifying services to best meet their needs. Case managers and navigators not only helped to determine participants’ eligibility for various internal and external services, but also administered assessments, provided referrals, and followed up with participants to help them engage in services. Cook Inlet Tribal Council‘s Navigation Team greeted individuals when they entered the building, administered the common assessment, and provided a warm handoff to Cook Inlet Tribal Council services. Navigators also checked in with participants throughout their experience to ensure continued access to the supports they needed—especially when they participated in multiple services. Maine Foster Youth to Independence matched youth aging out of foster care with a navigator who helped them access services and supports to build life skills once they were in housing. The Boulder IMPACT Partnership, which the Boulder County Department of Health and Housing described as an integrated system for coordinating care for children and youth across a range of human services providers in the county, included case planning, integrated staffing and case management for youth and families, and shared infrastructure across human services partners to coordinate services for their unique needs. Youth served by the Boulder IMPACT Partnership were either identified as at risk for system involvement, such as by being chronically absent from school, or were already involved in systems, such as foster care or juvenile justice. Partners included school districts, the district attorney, mental health providers, and other community partners. By bringing these partners together, the IMPACT Partnership could determine the best way to intervene to prevent further harm for the youth, such as by providing mental health care to a youth involved in the juvenile justice system to decrease the chance of continued involvement once they reached adulthood.