Social service integration

Social service integration efforts coordinate access to services across multiple delivery systems and disciplinary boundaries such as housing, disability, physical health, mental health, child welfare, and workforce services. Approaches to integrating and coordinating social services vary depending on community needs and service availability, and can be system- or sector-based, agency-based, or client- or family-based (King 2006*). Efforts can focus on improving collaboration across sectors, client pathways to service, or coordination and resource sharing across different levels of government (GI-Integration 2014*). 

Expected Beneficial Outcomes (Rated)

  • Improved access to social services

Other Potential Beneficial Outcomes

  • Increased enrollment in social services

  • Increased social service efficiency

Evidence of Effectiveness

Integrating social services is a suggested strategy to improve access to social services (Mathematica-Cody 2010, RAND-Europe 2012, MDRC-Support center), and reduce service gaps, fragmentation, and duplication (King 2006*, Packard 2013). Such efforts appear to increase access and enrollment, especially for veterans (Fisher 2012*) and vulnerable populations such as homeless people with mental illness and low income women who are pregnant or post-partum (Guerrero 2014*, Rosenheck 2001, YG-Program search). Social service integration is also recommended to better serve individuals with disabilities (Smith 2013*). A case study of the Care Coordination model suggests that health and social service integration can increase positive experiences among patients, reduce per capital cost, and improve health outcomes (IHI-Craig 2011*). However, additional evidence is needed to confirm effects.

Case studies and interviews suggest that successful efforts to integrate social services include a coordinating mechanism to manage collaboration, quality measurement and data-sharing tools to track outcomes and share information, and financing and payment methods that support and reward coordination (CWF-McGinnis 2014). Stakeholder involvement, strong commitment from an executive team, and aggressive marketing of mutual goals across agencies and departments can also improve service integration efforts (Packard 2013).

Community centers can offer a “one-stop shopping” model of service that coordinates access to social services (CDC-Community center).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

States are working to coordinate and integrate social services. Many states have restructured service delivery to: improve public, non-profit, and private sector collaborations, develop place-based service integration, enhance client pathways to service, and coordinate programs and resource sharing across different levels of government (GI-Integration 2014*).

Several counties and states have adopted one-stop office models of service. Examples include San Mateo County, CA; Mesa and El Paso County, CO; Bibb County, GA; Jefferson County, KY; the state of Nebraska; Montgomery County, OH; Coos and Jackson Counties, OR; Fairfax County, VA; and Racine and Kenosha Counties, WI (Rockefeller Institute-Service integration). Other states have established integrated social service delivery systems through Medicaid Accountable Care Organizations (ACOs), as in Colorado, Maine, Minnesota, Oregon, and Vermont (CHCS-Mahadevan 2015). 

Implementation Resources

CWF-McGinnis 2014 - McGinnis T, Crawford M, Somers SA. A state policy framework for integrating health and social services. Commonwealth Fund (CWF). 2014.

Citations - Evidence

* Journal subscription may be required for access.

Mathematica-Cody 2010 - Cody S, Reed D, Basson D, et al. Simplification of health and social services enrollment and eligibility: Lessons for California from interviews in four states. Princeton: Mathematica Policy Research (MPR); 2010.

RAND-Europe 2012 - RAND Europe, Ernst & Young LLP. National evaluation of the DH integrated care pilots. RAND Health Quarterly. 2012;2(1):8.

MDRC-Support center - Manpower Demonstration Research Corporation (MDRC). Work advancement and support center demonstration.

King 2006* - King G, Meyer K. Service integration and co-ordination: A framework of approaches for the delivery of co-ordinated care to children with disabilities and their families. Child: Care, Health, and Development. 2006;32(4):477-492.

Packard 2013 - Packard T, Patti R, Daly D, Tucker-Tatlow J. Implementing services integration and interagency collaboration: Experiences in seven counties. 2013;37(4):356-371.

Fisher 2012* - Fisher MP, Elnitsky C. Health and social services integration: A review of concepts and models. Social Work in Public Health. 2012;27(5):441–68.

Guerrero 2014* - Guerrero EG, Henwood B, Wenzel SL. Service integration to reduce homelessness in Los Angeles County: Multiple stakeholder perspectives. Human Service Organizations: Management, Leadership & Governance. 2014;38(1):44-54.

Rosenheck 2001 - Rosenheck R, Morrissey J, Lam J, et al. Service delivery and community: Social capital, service systems integration, and outcomes among homeless persons with severe mental illness. Health Services Research. 2001;36(4):691–710.

YG-Program search - (YG), Interagency Working Group on Youth Programs (IWGYP). Evidence-based program directories: Program directory search.

Smith 2013* - Smith TJ. One Stop Service Center Initiative: Strategies for serving persons with disabilities. Journal of Rehabilitation. 2013;79(1):30-36.

IHI-Craig 2011* - Craig C, Eby D, Whittington J. Care Coordination model: Better care at lower cost for people with multiple health and social needs. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2011.

CWF-McGinnis 2014 - McGinnis T, Crawford M, Somers SA. A state policy framework for integrating health and social services. Commonwealth Fund (CWF). 2014.

CDC-Community center - Alcaraz R. New community center to prevent youth violence. Atlanta: Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services (US DHHS).

Citations - Implementation Examples

* Journal subscription may be required for access.

GI-Integration 2014* - Governing Institute (GI), KPMG Government Institute. The integration imperative as the driver of reform: US state and local government innovations in human and social services delivery. 2014.

Rockefeller Institute-Service integration - Nelson A. Rockefeller Institute of Government. Case studies in service integration: Metros.

CHCS-Mahadevan 2015 - Mahadevan R, Houston R. Supporting social service delivery through Medicaid Accountable Care Organizations: Early state efforts. Center for Health Care Strategies (CHCS). 2015.

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