When the Social Security Act was passed in 1935, it became the first safety net program run by the federal government of the United States. In the more than 80 years since almost a dozen other federal programs have been created to address needs that range from nutrition to healthcare to education. State governments also run their own array of social services. Some state managed services, like Medicaid, are partnerships with federal programs, while others are run independently. In addition to government run social services, there are literally thousands of nonprofit organizations (NPO) that exist to address a wide variety of social and economic needs.
The advantage of a large number of available programs is that services exist to address a wide variety of needs across countless demographics and geographic regions. The disadvantage is that while there are some attempts at cooperation, many of these programs and services are run completely independently of each other. This fragmentation of services creates problems for both the clients and the providers. For the clients, prospective recipients of services are required to locate multiple agencies before they even have the opportunity to collaborate with separate caseworkers for each of their unique needs. Service and data silos mean that providers are often asked to solve complex problems with only partial access to a client’s information, limiting their understanding of the full picture. Or, providers may recognize the complete needs of an individual but be restricted by funding regulations, or other policies, from providing services outside of their specialization.
The need to treat clients holistically instead of viewing their needs as isolated cases may seem obvious, but practical solutions have not been easy to develop in an environment of complex funding regulations, program specialization, and privacy laws. Thankfully, some NPOs, government programs, and even insurance companies have begun to think outside of the box and create programs that provide more effective and efficient services by focusing on whole person care.
A Partnership to Break Down Silos
In Houston, Texas, a program known as Integrated Care for the Chronically Homeless (ICCH) was created to provide permanent supportive housing for individuals who experience both chronic homelessness and complex medical needs. Utilizing a section 1115 Medicaid waiver that allows for more flexibility in funding utilization, ICCH functions as a three-way partnership between a health services provider, a homeless services provider, and a housing services provider. Like other “Housing First” models, ICCH provides stable housing as a starting place for individuals to be able to address the other critical needs in their life, but it does not stop there. By including all three providers in the same program, clients are able to have access to the services that they need rebuild their lives.
The complex partnership has not always run smoothly, as each organization has their own policies and procedures. There has also been the occasional need to negotiate which organizations are responsible in cases of overlapping services or areas that don’t normally fall under any of the partners’ traditional models. Difficulties aside, the program has seen a great deal of success. Individuals who have been enrolled in ICCH for at least two years have seen an 82% reduction in emergency room visits. This reduction translates to both improved health for the individuals and lower costs for healthcare providers. ICCH has also reported clients who have been able to return to the workforce after receiving their services.
HUD Tackles Fragmentation
In December of 2017, the U.S Department of Housing and Urban Development (HUD) announced a plan to build a series of EnVision Centers as part of a new demonstration that is designed to help HUD program recipients work towards self-sufficiency. These centers will be built near public housing developments and are intended to function as a central location for resources that will focus on what HUD refers to as “the four pillars of self-sufficiency”:
- Economic Empowerment
- Educational Advancement
- Health and Wellness
- Character and Leadership
The resources located at Envision Centers may be provided by government, non-profit, or industry providers. By creating a central location, HUD hopes to allow recipients to easily access a full range of services, while also providing an opportunity for service providers to collaborate as they address the complex needs of individuals. In addition to the physical centers, HUD has also announced the development of a mobile app that is designed to help HUD recipients access the full resources that they need to gain self-sufficiency.
As part of their explanation of EnVision centers, HUD stated that “Intentional and collective efforts across a diverse set of organizations are needed to implement a holistic approach to foster long-lasting self-sufficiency.” There is a vast and diverse set of organizations, both government and nonprofit, that have specialized in specific needs across the social services spectrum. An unintended result of this specialization has been a fragmented approach that creates barriers to treating individuals holistically. If social services providers are going to make valuable strides towards improving individual lives while also controlling costs, the key is going to be finding innovative ways to collaborate and develop strategies that address a whole person instead of an isolated need.