IIIIlllIllIII 11111111111111 lllllllllllllll LM101784 For T Department of Health, Education, and Welfare and Other Federal Agencies Fourteen Federal programs were reviewed to determine the amount of funds provided for transportation services to the elderly. Cost estimates were available on only two of these programs--about $5 million in fiscal year 1976. GAO and others are doing work that relates to coordinating various Federal programs by providing social services at centralized loca- tions. HRD-77-68 ' APRIL 711977 COMPTROLLER GENERAL OF THE UNITED STATES WASHINGTON. D.C. 20548 B-169491 The Honorable Mario Biaggi Chairman, Subcommittee on Federal, and Community Services Se?kzEe&ommittee on Aging Hs&q& 1 House of Representatives Dear Mr. Chairman: In a letter dated June 30, 1976, former Chairman Spark M. Matsunaga told us about the Subcommittee's efforts to identify the transportation problems of older Americans. He also sent us a copy of the Subcommittee's report, "Senior Transportation: Ticket to Dignity." That report recommended, among other things, that we (1) make a study to identify all significant amounts of Federal money being spent on trans- porting older Americans and (2) review practices and require- ments for locating federally financed public facilities and recommend ways to promote more centralized sites and multiple agency use of such facilities so that these agencies can better serve their clients. In later discussions with the former Chairman's office, we agreed to: --Review a report on the amount of funds and the scope of certain services being supplied to elderly participants under six Federal programs that are the major funding sources for trans- portation services for the elderly. This report was developed for the Administration on Aging by Mr. Joseph Revis, a consultant with the Institute of Public Administration. --Describe any efforts, by us or others, that relate to coordinating various Federal programs by providing social services at centralized locations. --Provide all cost information readily available on a list of transportation programs provided by the Subcommittee staff and describe problems encountered in obtaining this data. B-169491 '--Describe our work related to (1) identifying all Federal programs providing transportation services and (2) surveying the impact of Federal programs on the elderly in Cleveland, Ohio. This letter is our response to the Subcommittee's recom- mendations, as modified in the discussions cited above. We obtained this information during discussions with officials from the seven Federal agencies administering the programs we were asked to review. (See app. I.) REPORT BY JOSEPH m--wREVIS A January 1975 report entitled "Transportation for the Elderly: The State of the Art," published for the Adminis- tration on Aging, identified a range of transportation problems confronting older Americans. The November 1976 Revis report, entitled "Transportation for Older Americans - 1976: Progress, Prospects, and Potentials,“ documents the progress made since the earlier report in terms of (1) how much funding is being allocated for transportation services for the elderly, and by whom, (2) to what extent agencies providing transportation funds are coordinating with one another, and (3) to what extent the transportation problems and requirements of the elderly have changed since 1975. We understand that a copy of the Revis report has been provided to the Subcommittee. The information in the Revis report was obtained pri- marily from two sources: State agencies on aging, which were asked to provide information on coordinating and fund- ing transportation projects, and witnesses who testified at four public hearings held by the Administration on Aging in 1975 and who were later asked to update their testimony. Fundina data developed The Revis report stated that, of 56 State agencies on aging (States and territories), 38 were able to provide in- formation on transportation funding under titles III and VII of the Older Americans Act of 1965, as amended, 42 D.S.C. 3001 (1970 and Supp. V, 1975), which provide for developing sub- State comprehensive coordinated service systems, and provide congregate meals and social services for the elderly, respec- tively. They reported that, of 1,308 transportation projects, 65 percent were funded under title III, 25 percent were funded under title VII, and 10 percent were funded jointly under both titles for fiscal year 1975. Based on the 1,308 transportation projects, the Revis report projected a total of 2,000 projects 2 l3-169491 funded for fiscal year 1975 by all 56 State agencies on aging. Another 500 projects were funded during this time under sec- tion 16(b) (2) of the Urban Mass Transportation Act of 1964, as amended, 49 U.S.C. 1612(b)(2) (Supp. V, 1975), and section 147 of the Federal-Aid Highway Act of 1973, Public Law 93-87. Transportation funding for older Americans during fiscal year 1975 was estimated at between $64.3 million and $69.8 million. These amounts consisted of $15 million from title III; $8 million from title VII; $12.5 to $16.6 million from section 16(b)(2); $4.7 to $6.1 million from section 147; and $25 million from title XX of the Social Security Act of 1935, as amended, 42 U.S.C. 1397 (Supp. V, 1975). (See app. II.) These estimates were based on data provided by the State agencies on aging and published information available on sec- tion 16(b)(2), section 147, and title XX. Sufficient data was not available to permit funding estimates for transportation services from title XIX of the Social Security Act of 1935, as amended, 42 U.S.C. 1396 -et em seq. (1970 and Supp. V, 1975). Coordination The Revis report said that State agencies on aging re- ported varying experiences in coordinating titles III and VII programs. Over 80 percent (28 out of 32 responding) said there were barriers to coordinating transportation services, and most States cited more than one barrier. The barriers and the percentage of the States that cited them were: funding (33 percent), system operating problems (22 percent), client or user restrictions (19 percent), organizational problems (17 percent), and conflicting State and/or Federal interpreta- tions and guidelines (9 percent). Twenty-eight State agencies responding to the request for data made recommendations dealing primarily with ways to improve the use of titles III and VII funds and to improve coordination among transportation programs serving the elderly. The witnesses generally agreed on the value of coordination. Changes in transportation problEiiEsiGe - early -I_ 1975 During the four hearings held by the Administration on Aging in February and March 1975, six major transportation issues were identified: (1) the lack of adequate public transportation in urban ureas, (2) problems the elderly encountered in using transportation systems, (3) problems in coordinating resources and programs, (4) problems with 3 B-169491 funding and continuity of funding, (5) problems in expand- ing the use of existing resources, and (6) the lack of transportation in rural areas. Forty-seven agencies and individuals from varying backgrounds were recontacted during this study and asked to update their previous testi- mony. Witnesses felt that raising political consciousness about mobility needs of the elderly was no longer as necessary as it had been a year earlier. They showed an awareness of (1) the costs necessary to meet the needs of the elderly and (2) how the present constraints on public transportation limit the ability to respond to the parti- cular travel needs of certain groups, including the elderly. The observations of the witnesses during the most recent discussions were divided into five major categories: --Transportation coordination. The witnesses understood that coordination could result in cost savings through less duplication of services and facilities.- Although the witnesses generally agreed on the value of coordi- nation, they also identified barriers to coordination. --Public transportation programs. Witnesses expressed diverse views on (1) the impact of reduced-fare pro- grams on the mobility of the elderly, (2) the further extension and refinement of the effect of the Urban Mass Transportation Act's section 16(b)(2) program (which provides grants to private nonprofit corpora- ' tions and associations for providing transportation services specifically for the elderly and handicapped),' and (3) the disappointment with the outcome of the urban Mass Transportation Administration's Transbus program (which provided a prototype bus that was more efficient, attractive, and accessible, thus better suited to the needs of the elderly and the handicapped). --Franchise conflicts. The witnesses again cited the problems special service transportation systems can anticipate when their operations conflict with con- ventional franchised services, such as taxi opera- tions, handicapped services, and the charter bus in- dustry. --Use of school buses. There has been almost no recent expanded use of idle school buses for transporting the elderly. --Funding programs. Concern was expressed about future funding problems. Some witnesses were optimistic that 4 B-169491 local sensitivity, through tax support, would help meet the special transportation needs. Shortcomings in data collection The findings and conclusions in the Revis report were based on the States' and witnesses' responses. The States had problems understanding the questionnaire, mainly because the researcher did not have enough time to pretest language and clarity. However, conversations with individuals fami- liar with the problems of transportation coordination did result in some revisions to the questionnaire before it was . administered. Another problem was that the questionnaire was mailed during the period when the States were busy planning their fiscal year 1977 budgets. The States often did not have the information re- quested. In many instances, their answers were inconsistent and large sections of the funding tables were left incomplete or marked "not available" or "insufficient information avail- able." Many States did not collect the information in the format required, often because their accounting or adminis- trative regulations did not require such data. To develop such information, two steps are necessary: (1) States would have to be required to collect such data on a uniform basis and (2) they would have to be given enough time to collect such information on a project-by-project basis. We did not evaluate the methodology used or verify the statistics developed in this report. GAO REVIEW AND EFFORTSBY OTHERS ON COORDINATING VARIOUS FEDERAL PROGRAMS AT CENTRALIZED SERVICE DELIVERY SITES Our review We are reviewing the opportunities available for improv- ing information and referral services for needy aged, blind, disabled, and other persons. Many reports have noted that few people in any community have accurate knowledge of the many social services available to needy persons. Because of the large number and different kinds of available community services, it is difficult for these persons to find the help they need without assistance from an effective information and referral service. Such a service should link the needy to the social services they require, such as rehabilitation, transportation, housing, family planning, counseling, employ- ment, and many others. 5 B-169491 we are primarily concerned with the adequacy of information and referral services for the needy aged, blind, and disabled because these people have a special need for effective information and referral. The needs of others are also being considered, since virtually any person may require help in receiving community social services. We hope to issue a report on what opportunities exist to improve information and referral services for the needy aged, blind, disabled, and other persons in June 1977; we will send you a copy at that time. Department of Health, Education, and Welfare prolects In January 1976 the Department of Health, Education, and Welfare began operating Project Share--a national clearinghouse for improving the management of human serv- ices. This project was created to meet State and local officials' needs for current information on innovative approaches to improving the planning and management involved in delivering human services. Many projects funded by the Department and many reorganizations under- taken by States and localities on their own initiative have been implemented. Project Share makes information available on such projects to those who should be aware of them. Project Share places a special emphasis on informa- tion about integrating services at the delivery level. The project recently published a bibliography series that contained evaluations of demonstration projects on serv- ices integration. (See app. IV.) Additional information is made available to those writing or telephoning Project Share requesting research to determine whether other stud- ies have been done on integration or colocation of services. The Department is funding a services integration proj- ect in Pennsylvania that it considers to be quite successful. This project involves coordinating various programs at cen- tralized service delivery sites. Appendix III describes this project and its goals. COST INFORMATION ON SELECTED TRANSPORTATIONPROGRAMS We attempted to identify the amount of Federal funds be- ing spent on transporting older Americans under 14 programs 6 B-169491 listed by the Subcommittee staff. We were able to obtain cost data on only two of these programs--Foster Grandparents and Senior Companion--both administered by ACTION. These two programs are required to provide transportation services only to the programs' volunteers, who must be at least 60 years old and be at or below the poverty level. For the other 12 programs, transportation estimates could not be provided for varying reasons. Some program officials said that the data was not available but that, if it were, it would show the amounts spent for transpor- . tation to be very small. Other programs do not show trans- portation as a line item in their budgets. The programs administered by the Urban Mass Transportation Administration which serve the public could provide a combined estimate of transportation costs for the elderly and the handicapped, but a separate breakdown between them was not available. Other program officials said that transportation costs would have to be identified at the local project level--a difficult and time-consuming process because such costs are considered part of the total program cost and are not accounted for separately. Appendix I describes our efforts to obtain the cost information. OTHER GAO STUDIES Your office expressed interest in two studies we have in process. Another study that may'be of interest con- cerns the Urban Mass Transportation Administration's actions regarding the needs of the elderly and the handi- capped. The nature and objectives of these studies are described below, and copies of the reports will be sent to you when they are issued. Review of Federal programs which provide for the transportation of people in rural areas The Senate Committee on Public Works requested us (1) to make a comprehensive review of Federal programs which in some manner support transportation of people in rural and small urban areas and (2) to identify how specific program requirements frustrate local efforts to coordinate transportation components of various programs in a locality. Specifically, the Committee asked us to 7 .,. B-169491 ,--identify all Federal grant and assistance programs which provide Federal funds for transporting people within rural and small urban areas and between these areas and large urban areas: --identify restrictions on the use of Federal funds under each program and the source of these restric- tions; --determine the extent to which the restrictions frus- trate Federal, State, and local efforts to provide a coordinated transportation service; --identify instances in which coordination has been achieved and the circumstances that made it possible; and --make recommendations for eliminating Federal restric- tions that hinder coordination of transportation programs. Transportation is the primary objective of only a few programs, such as those administered by the Department of Transportation. However, in many Federal programs, such as the human services programs, transportation is a vital serv- ice supporting the primary program objective. Because most programs providing transportation are not geographically restrictive --they are targeted to all areas, urban and rural-- we expanded our review to encompass all Federal grant and assistance programs providing transpor- tation as a service, whether directly or indirectly. We are also making 12 case studies on transportation projects which have coordinated or consolidated Federal trans- portation services to some extent. The general approach we used in developing a case study for each transportation system was to determine the source of Federal funding, the cause of any restrictions and problems encountered, and how these re- strictions and problems were overcome. In addition, we will describe the system, its history, and the environment in which it operates. Study of the impact of Federal programs on the elderly in Cleveland We have identified at least 134 Federal programs which assist the elderly. To measure the impact of these programs, we interviewed a random sample of more than 1,600 people, 65 years or older, in Cleveland, using a questionnaire developed 8 B-169491 at the Duke University Center for the Study of Aging and Human Development. The questionnaire was used to determine each individual's well-being at one point in time. In addi- tion, we identified the providers of services to the elderly in Cleveland, including families, friends, and over 100 social service agencies, and obtained information on the services provided to each person in our sample and the source and type of service. Funding for the social service agencies was provided under 23 Federal programs; State, county, and city governments: and private sources. By relating the above data to each individual, we per- formed comparative analyses of our sample. We are preparing a report on the analyses results that will (1) discuss the well-being of older people, (2) describe the assistance they are receiving, and (3) provide insights into issues relating to the many programs designed to help them. We are reinterviewing our sample of older people 1 year later to identify changes in their well-being over the year and are again gathering data on services provided. After collecting and analyzing this additional information, we will report on the changes in well-being and the factors influencing those changes. This should help to identify what effects the programs have on the lives of older people and what the Congress, the executive branch, State and local governments, and others can do to improve older people's lives. Mass transit for elderly and handicapped persons: Urban Mass Transportation Administration actions Our primary objective in this review is to determine the effectiveness of the agency's efforts under the Urban Mass Transportation Act of 1964, as amended, to see that the transportation needs of the elderly and the handi- capped are being met. Specifically, we are (1) reviewing the administrative and legal actions taken by the agency to meet these needs, (2) determining the effect of such actions, (3) determining how the plans required under several capital grants approved in the last few years have provided for the transportation needs of the elderly and the handicapped and determining whether they have been carried out, (4) determining how the plans for several recently approved capital grants address the problem of providing transportation to meet these needs, and (5) reviewing the research and development projects and other 9 B-169491 special projects the agency has undertaken to help urban areas meet these needs. Applications for Urban Mass Transportation Adminis- tration grants for urban capital assistance and operating subsidies are required to describe planning that addresses the transportation needs of the elderly and the handicapped. This description, required for both long- and short-range plans, is to help insure that the elderly and the handi- capped can use mass transit facilities and services. We will be determining how the agency perceives its role and responsibilities regarding transportation for the elderly and the handicapped in accordance with the national policy set out in section 16(a) of the Urban Mass Transportation Act of 1964, as amended. This section states that: ‘* * * elderly and handicapped persons have the same right as other persons to utilize mass trans- portation facilities and services; that special efforts shall be made in the planning and design of mass transportation facilities and services so that the availability to elderly and handi- capped persons of mass transportation which they can effectively utilize will be assured: and that all Federal programs offering assistance in the field of mass transportation (including the pro- grams under this Act) should contain provisions implementing this policy.” We hope to issue the report in early 1977. Copies of this report are being sent to Senator Matsunaga. Sincerely yoursl ACTING Comptroller General of the United States 10 Contents Page APPENDIX I Data on selected programs affecting transportation for the elderly 1 II Estimate by the Institute of Public Administration of funding for transportation services for older Americans 4 III Summary of a services integration project in Pennsylvania 5 IV Evaluation of services integration demonstration projects 7 APPENDIX I APPENDIX I --DATA ON SELECTED ------ PROGRAMS AFFECTING TRANSPORTATION FOR THE ---- ELDERLY Estimated total transportation Estimated program obl igat ions, Responses to GAO efforts to obligations, fiscal fiscal obtain estimates on ttanspor- Agency ---___--- and authority year ------ 1976 year ----- 1976 tatlon costs ---------_------------- for the elderly Department of Health -L--- Edu- dationaz-welfar --L--e e Emergency Medical Serv- $29,115,000 Amount not Transportation 1s 1 of 15 ices System Act of significant actlvlties provided by p!o]- 1973 ect grantees. Fmer gency ambulance service 1s the transportation pl ovlded. A1 - though an estimate of trans- portatlon cost coul~-l not :w provided, an agency oEf 1c131 thought It would be neqll- glble. Rehabilitation Act of 720,309,318 b/$18,471,000 Estimates on the costs of 1973 (note a) transportation benefits to the elderly are not availaole. This information would have to be developed by the States, which would be hard plessed to accumulate the data. Agency officials estimated that the amounts related to tr ansporta- tion for the elderly are ex- tremely small. Department _---_---- of Transportation Urban Mass Transportation 1,100,000,000 1,100,000,000 This program focuses on over- Act of 1964, as amended, all improvements to transpor- section 3, Capital Improve- tation systems. It does not ment Grants concentrate on a particular target group, such as the elderly, but relates to the general population. This pro- gram has obligated an esti- mated $27 million c/ on capital assistance-projects that are to specifically consider the needs of the elderly and the handi- capped. However, a separate estimate for the elderly is not available. Urban Mass Transportation 390,200,000 390,200,000 Section 5 does not focus on Act of 1964, as amended, a particular target group, section 5, Formula Grant such as the elderly, but is Program intended to benefit the pub1 ic. An estimated $1 million was obligated for projects specifically considering the needs of the elderly and the handicapped combined for fiscal year 1976. However, a separate estimate for the elderly is not available. Urban Mass Transportation 53,400,000 53,400,000 For fiscal years 1970-76 an Act of 1964, as amended, estimated $145.9 million has section 6, Research, been obligated for many multi- Development, and Demon- year projects that specifi- stration Projects cally consider the needs of the elderly and the handi- capped combined. However, a separate estimate for the elderly is not available. 1 APPENDIX I AP;PENDIX I Estimated total transportation Estimated program obligations, Responses to GAO efforts ti; obligations, fiscal fiscal obtain estimates on t! anspor - Agency and authority year - 1976 year1976 -- tatlon -------------------- costs for the elderly Urban Mass Transportation $38,700,000 $38,700,000 An estimated $3.6 million was Act of 1964, as amended, obligated fat planning that section 9, Grants for specifically considered the Technical Studies needs of the elderly and the hand Icapped combined. An agency official stated that separate data on the elder ly is not available because there 1s no legislative requirement to collect It. No efforts are foreseen to develop this type of data. Department of -- Labor Older Americans Community 30,000,000 Unavailable Agency officials could not Services Employment Act provide a cost estimate for transportation services because transportation 1s not a line Item in the budget. Community Services -- Administration Title II, Economic Oppor- 330,000,000 15,180,000 Data is not available at tunity Act of 1964, as headquarters on transporta- amended, sections 212 and tion services provided by the 221, Community Action Pro- local projects. Expend I- grams tures are charged to only two categories--administratlve and program funding. At- tempts to obtain lnfocmation on transportation expendl- tures locally would be dif- ficult and :ime consuming be- cause transportation is considered part of the total program expense and is not accounted for se- parately. Title II, Economic OppOr- 10,000,000 Unavailable Data is not available at tunity Act of 1964, as headquarters. An agency amended, section 222(a) (7)) official doubted whether Senior Oppoctunlties and we could get the Informa- Services Program tion locally. The grantees use the funds as needed and have neither the faci- lities nor capabilities to account for transportation costs separately from other project costs. ACTION Title II, Domestic Volun- 17,500,000 Unavailable An estimate of expenditures teer Service Act of 1973, for transportation services as amended, section 201, could not be provided. An Retired Senior Volunteer agency official said that he Program contacted several persons who maintained financial data on the program but that they were unable to give him any estimates. The reason for not providing an estimate was because this type of data was not maintained. 2 APPENDIX I APPENDIX I Estimated total transportation Estimated program obligations, Responses to GAO efforts to obligations, fiscal fiscal obtain estimates on transport- Agency and--- authority year ---- 1976 year ---- 1976 tation -------------------- costs for the elderly Title II, Domestic Vol un- $28,347,000 $4,773.600 Since all the volunteers are teer Service Act of 1973, 60 years old or over and as amended, section 211(a), the program must provide Foster Grandparents Program transportation for the volun- teers (not the program recipients), all the estl- mated transportation costs benefit the elderly. The estimated cost was com- puted by mu1 tiplying together the number of budgeted volunteers, the average transportation cnst per day per volunteer, and the maximum number of serv- ice days (260) per year per volunteer . This method as- sumes that volunteers work 5 days a week, 52 weeks a yeaL , without allowances for sick, annual, or hol,iday leave and that they remain in the pro- gram for the entire fiscal year. Title II, Domestic 4,545,ooo 351,000 Same as section 211(a) above. Volunteer Service Act of 1973, as amended, section 211 (b) , Senior Companion Program Department of Housing Urban Development Title I, Community 2,353,105,000 6,468,OOO No cost estimate could be Development Block Grants, provided for transporting Housing and Community the elderly. To identify Development Act of 1974 transportation-related proj- ects would require con- tacting all the title I grantees. Transportation is not a line item in the budget. Department of the Treasury State and Local Fiscal 6,500,000,000 Unavailable An estimate of what was Assistance Act of 1972, being spent on transportation as amended (General Re- could not be provided. venue Shar ing ) Although the revenue shar- ing reporting system includes a public transporta- tion category, it contains expenditures for building and repairing roads as well as for purchasing or operating buses. This information is not requested because the law only specifies broad spending categor ies. a/The figures cited for this act include only allotments under section IlO--Basic State Grants. b/Does not include information from 12 States that were unable to provide estimates. c/This includes $22 million for the section 16(b)(2) program--Capital Grants to Private Nonprofit Organizations. 3 APPENDIX II APPENDIX II ESTIMATE BY THE INSTITUTE OF PUBLIC ADMINISTRATION OF FUNDING FOR TRANSPORTATION SERVICES FOR OLDER ---- AMERICANS MAJOR FEDERAL SOURCES, FISCAL YEAR 1975 ---~- Estimated Estimated funding Estimated transpor- Act and title Program transporta- for transpor- tation funding for or section --amount tion share --- tation older Americans -------__- (millions) (percent) _ (millions) Older Americans Act: Title III a/$ 97.0 15.0 $15.0 $15.0 Older Americans Act: Title VII 124.5 6.0 8.0 8.0 Urban Mass Trans- portation Act: section 16(b)(2) 20.8 100.0 20.8 b/12.5 - 16.6 Federal-Aid High- way Act: section 147 9.4 100.0 --9.4 -b/4.7 ----- - 6.1 251.7 52.3 $39.3 - $44.8 Social Security Act: Title XX (note c) 2,506.O d/2.0 50.0 e/25.0 --- Total $64.3 - $69.8 a/Excludes model projects funds. b/Program is not exclusively for the elderly, but the elderly represent a sub- stantial share: the lower limit assumes that 60 percent and 50 percent of sections 16(b)(2) and 147, respectively, are serving the elderly; the upper limit assumes these shares to be 80 and 65 percent, respectively. c/Detailed transportation data was not available. d/This percentage is based on 1.7 percent for transportation as reported by the Subcommittee on Federal, State, and Community Services, House Select Committee on Aging, in its report "Senior Transportation--Ticket to Dignity," May 20, 1976, p. 24. e/Assumes the share of the elderly is proportional to their share of the num- - ber of persons receiving Supplemental Security Income--about 50 percent. Data is from Senate Special Committee on Aging, "Developments in Aging: 1975 and January-May 1976," Part 1, June 26, 1976, p. 73. Source: "Transportation for Older Americans-1976: Progress, Prospects, and Potentials." APPENDIX III APPENDIX III SUMMARYOF A SERVICES INTEGRATION PROJECT IN PENNSYLVANIA In October 1972, the State of Pennsylvania established a demonstration project called the "Wyoming Valley Social Serv- I ice System" and created an agency called the United Services Agency in Luzerne and Wyoming Counties, using moneys provided for damages caused by Hurricane Agnes. The agency was to ini- tiate a single-entry social services system, integrating so- cial services administered by State offices on child welfare, day care, the aging, adult welfare, mental health/mental re- ' tardation, juvenile probation, and juvenile detention and the county boards of assistance. The agency assumed all fiscal and administrative responsibility for these eight public agen- cies, began to integrate them into one system, and has estab- lished five of six proposed multiservice centers for service deliveries. The United Services Agency delivers services in coopera- tion with various public and private social service agencies through contractual arrangements. Included in this delivery system is a management information system which will improve (1) coordination between service delivery sites and clients, (2) management controls and reporting, and (3) quality and uti- lization controls through a system which can determine patterns of client use and public or private provider practices. This demonstration project is authorized under title XI, section 1115, of the Social Security Act. The State of Penn- sylvania provides one-fourth of the funds and receives the other three-fourths from Federal matching funds from title Xx of the Social Security Act. Social and Rehabilitation Service officials said that fiscal year 1977 would be the last year of the project. However, they are optimistic that the project will be continued at least in part through State and local funding. The overall goal in continuing this project is to further develop the delivery of public social services through an inte- grated, synthesized system with centralized administration and fiscal control. The system's potential transferability to other parts of Pennsylvania and to other State and national programs will be assessed during this final project year. The United Services Agency hopes to transfer the management in- formation system, a coordinated information and referral/ crises intervention program, a centralized transportation unit, the housing services unit, and a system of one-stop neighbor- hood service centers. 5 APPENDIX III APPENDIX III ,Also in this final project year, a financial management information system will be developed to provide cost data on all aspects of the agency's integrated services project. Reports expected from this system include: --Cost of service delivery by service unit, providing a cost comparison of delivery costs by different pro- viders. --Cost of service delivery by funding source. --Cost of service delivery by goal, to identify the ex- pense involved in client progress. --Service delivery costs in relation to common service plans. --Family profile of costs of service for certain time periods. Social and Rehabilitation Service officials stated that the cost of service delivery is a crucial item in this proj- ect. All other project aspects have been very successful. This project has been presented to national conferences spon- sored by such organizations as the American Public Welfare Association and the National Conference on Social Welfare. It has been rated as one of the top five services integration, projects in the United States in a recent Brandeis University study. However, if the costs of service delivery outweigh the benefits, the concepts developed may not be as applicable ' as hoped. The Social and Rehabilitation Service plans to use the data developed by the United Services Agency, combine it with similar data from other services integration demonstration projects, and present it to interested officials from the Service and other agencies. If accepted by these officials, the concepts developed might be implemented nationally. The United Services Agency is trying to get the State legislature to implement its concepts by drafting legislation to establish similar programs statewide. In fact, two other Pennsylvania counties, Lehigh and Northampton, have recently voted for a new county charter that will reorganize their county governments to include departments of human services, with an interest in establishing integrated service systems. The agency plans to work closely with these counties and transfer the concepts developed to the new county structures. 6 APPENDIX IV APPENDIX IV NUMBER 1 JUNE 1976 A National Clearinqhou>e for Improwinq the fRanaqement of t-luman Service3 APPENDIX IV APPENDIX IV EVALUATION OF SERVICES INTEGRATION DEMONSTRATIONPROJECTS The Department of Health, Education and Welfare has funded a number of projects over the past five years to test out various human service linkage mechanisms such as integrated planning, new case management approaches and integrated information systems. A body of literature has now been developed which documents the evaluations of these demonstration projects: These evaluations have been collected by PROJECT SHARE, and bibliographical information and abstracts of the documents are presented on the fol- lowing pages. The documents range from evaluations of individual projects to aggregate evaluations of a number of SIT0 projects such as those prepared by AHT Associates, Har- bridge House, The Human Ecology Institute, Marshall Kaplan, Gans and Kahn and the Rand Corporation. The reader will note that some of the evaluations were project self- assessments, and others particularly the collective evalua- tions were performed by persons in no way associated with the projects being evaluated. 8 APPENDIX IV APPENDIX IV THE BIBLIOGRAPHY SERIES The PROJECT SHARE Bibliography Series is intended to acquaint users of the Clearinghouse with the contents of the PROJECT SHARE collection with respect to selected subjects. The subjects addressed are chosen to reflect the current interests and priorities indicated by users of the Clearinghouse. The Bibliographies are not intended to be an exhaus- tive cataloguing of all documentation of the selected topics. Rather, they are to inform users of the informa- tion which may be obtained through PROJECT SHARE. We hope that this service is of help in your efforts to improve your planning and management of human services. Any questions, comments or criticisms you may have concerning the Journal of Human Services Abstracts or PROJECT SHARE should be addressed to Mr. William Privett, Project Officer at the following address: PROJECT SHARE P.O. Box 2309 Rockville, Maryland 20852 301 881-4063 9 APPENDIX IV APPENDIX IV Aggregating Organizational Experience wi "_k :crvi,-, ; Integration: Feasibility and Design. William A. Lucas. Rand Corp., Santa Monica, California. Apr 75, 39p SHR-0000464 Available from PROJECT SHARE, $4.00. A feasibility study was conducted using the case survey method to compile information about the organizational processes of Services Integration Targets of Opportunity (SITO) projects and similar efforts. Four study areas were identified: (1) specification of outcomes that DREWand others desire to achieve through services integration; (2) review of the number and characteristics of SIT0 and non-SIT0 projects: (3) develop- ment of a conceptual framework to guide the selection of projects and variables; and (4) development and testing of a checklist or data collection guide and reiterative refinement of this checklist in light of data availability. These tasks were pursued through interviews and an examination of services integration literature. Discussions were conducted with past and present Federal officials closely associated with the SIT0 program. Federal region, State, and local project personnel were contacted to learn about services integration from their perspective and to identify non-SIT0 projects that could be included in an aggregative study. Conceptual work led to an organizational process model that could be used in structuring questions to be asked of services integration projects. Rigorcus requirements of the process model and the nature of available case histories on services integration led to the conclusion that a case survey method using only available materials should not be conducted. As an alternative, it was recommended that DHEWpossibly consider a research census, relying on available written materials but primarily collecting data by telephone and mail. A companion document is available as SHR-0000363. 10 APPENDIX IV APPENDIX IV Arkansas Regional Services Integration Project. Period Covered July 1, 1972 through August 30, 1975. Alcohol, Drug Abuse, and Mental Health Administration, Rockville, Maryland. Ott 75, 255~ Executive Summary available from PROJECT SHARE. SHR-0000323 Available from PROJECT SHARE, $9.00. The development of a model system of integrated health and social service delivery on a substate multi-county area is documented in this report of the Arkansas Department of Social and Rehabilitative Services. This development was to be accomplished by changing the pattern of service delivery among a select group of public social service providers from within the existing system. A second objective was to develop a research component that would enable the monitoring and evaluation of the performance of the model system. The pilot area is composed of 12 counties in Northeast and East- Central Arkansas. Part one presents introductory material concerning the general concept of the project; part two contains material on the environment at the outset of the project, the goals and objectives, and the actual processes operating during the project. The research report contained in part three is concerned with the second objective of the report, and includes methodology, results and effectiveness, efficiency, and responsiveness analysis. Part four presents the findings and describes the project impact and outcomes, as well as the various recommendations resulting from the project. Supplements are contained in part five, together with all appendices, charts and training manuals. . 11 APPENDIX IV APPENDIX IV Assessment of CSDS Service Integration and Linkages. Florida State Dept. of Health and Rehabilitative Services, Tallahassee. Bureau of Research and Evaluation. Feb 74, 44p SHR-0000490 Available from PROJECT SHARE, $4.00. The use of 'administrative and direct service linkages in the Florida State Department of Health and Rehabilitative Services (DHRS) comprehensive services delivery system (CSDS) project is assessed. Through some 289 separate linkages, the project staff initiated the multiservice concept in three pilot centers in Palm Beach County. Among specific administra- tive linkages identified are those concerning fiscal activities, personnel practices, planning and programming, and administrative support services. Some of the agencies participating in the CSDS project have either colocated in the pilot service centers or are recipients of purchase of services agreements. Among direct service linkages identified are those related to modes of case coordination and delivery of core services, including outreach, intake, diagnosis, referral, and follow-up. The linkages identified are said to indicate the level of communication existing between local social service agencies and CSDS project staff, as well as the level of communication within the service centers containing colocated agencies. Definitions of various integrating linkages, a tabular summary of integrating linkages employed in specific DHRS divisions and units, a summary of project activities with actual or potential linkage implications, and a list of agencies participating in the project are appended. 12 APPENDIX IV APPENDIX IV Census of Local Services Integration. 1975. A Working Note. Rand Corp., Santa Monica, California. Dee 75, 102~ Executive Summary available from PROJECT SHARE. SHR-0000297 Available from PROJECT SHARE, $5.50. Local comprehensive services integration projects studied by the Rand.Corporation under a U.S. Department of Health, Education, and Welafre (DHEW) contract are reviewed in this report. This report assesses alternative approaches to services integration. The study is based on a telephone "census" of 70 local projects. This I'census" was to include only those projects affecting the service system at the local level and involving two or more integrative links and two or more types of traditional agencies. Section I explores the nature of services integration. Section II examines the community, state and Federal contexts for services integration. Section III examines the relationship of planning and organizational change strategies to project outcomes. Section IV deals with the effectiveness of integration linkages. The report tentatively concludes that, in the absence of decisive DHEW initiatives, services integration will continue to be a marginal and isolated phenomenon. If DHEWwants a serious reorganization or changes in traditional service philosophy at the local level, it must be prepared to introduce a heavy commitment of funds and to change DHEW regulations to facilitate such activities. It was further concluded that if DHEWwishes to continue the existing types of activities, it must realize that: research and development funds will continue to be needed to initiate projects; the better programs may be picked up by categorical programs; extensive planning models are not absolutely necessary: and projects that first implement links involving continuing service staff interactions may progress better than other projects. Seventy project descriptions are included in the appendix. Also available report on methodology: Aggregating Organizational Experience With Services Integration: Feasibility and Design. SHR-0000464 Available SHARE, $4.00. 13 APPENDIX IV APPENDIX IV Community Life Association from 1972-1975. Greater Hartford Process, Inc., Connecticut. Jan 'id, 68p Executive Summary available from PROJECT SHARE. SHR-0000600 Available from PROJECT SHARE, $4.50. Research and development of a new service delivery model is reported by the Community Life Association (CLA) of Hartford, Connecticut conducted under an experimental Services Integration Target Organization (SIT01 grant. The three-year project, which ceased all operational activity on December 31, 1975, is evaluated for accomplishments and short- comings. Problems of the existing service system (fragmentation and duplication of services, lack of coordination) are delineated. The CLA model, which incorporated four basic innovative elements based on analysis of the above problems, is presented. These elements are: a pool of funds from public and private sources; purchase of services; case managers; and performance measurement. The development of the CLA is traced, and two programs within it-- the self support system and the personal care program--are described. Constraints encountered by the programs are discussed, and detailed conclusions are presented regarding the CLA methodology. In general, it was concluded that the methodology was a significant innovation that can effect a comprehensive, focused, and accountable system for planning, financing, and delivering human services. Lessons learned and closing remarks about the project are included, together with a chronology of major CIA developments. 14 APPENDIX IV APPENDIX IV Comprehensive Services Delivery System (Its Nature and History). Lantana, Florida. Florida State of Health and Rehabilitative Dept. Services, Tallahassee. Aug 74, 112~ Executive Summary available from PROJECT SHARE. PB-240 588 Available from NTIS, PC$5.5O/MF$2.25. The background and accomplishments of the Comprehensive Services Delivery System (CSDS) project undertaken in 1969 by the State Department of Health and Rehabilitative Services as a pilot program in Lantana, Florida, are reported in detail. The project entailed development of an approach to multiservice center staffing. The CSDS project viewed the service centers as the core of services integration and by June 1972 three such centers were fully operational. Center programs were varied, and included highly developed medical units, emergency financial assistance, adult basic education for the disadvantaged, and a behavioral-vocational assessment unit. Service centers drew staff from three separate groups: CSDS staff, U.S. Department of Health and Rehabilitative Services personnel, and personnel from other agencies. The CSDS project also represented an attempt to move an entire community toward services integration, and was not dependent on the service centers alone in this effort. The report evaluates techniques, special projects and accomplishments of the project. Included are recommendations drawn from every level of planning and implementation of the project as well as discussions of difficulties encountered relative to computerization, regionalization and definition of authority. 15 .,. APPENDIX IV APPENDIX IV Coordination of Selected Human Services Programs. Louisiana State Governor's Office of Federal Affairs and Special Projects, Baton Rouge. Office of Human Services Planning. 1974, 217~ Executive Summary available from PROJECT SHARE. SHR-0000473 Available from PROJECT SHARE, $7.75. Human services programs in Louisiana are examined to determine how they could be more closely coordinated to comply with the services integration concepts espoused in the Allied Services Act. The programs selected for evaluation are described in terms of purpose, services, administrative system, funding, and clients served. It was determined that the most feasible method of inventorying the service resources was to ascertain the number of clients served by each program, and questionnaires were mailed to the various agencies to supply this information. Another questionnaire was mailed to service providers requesting information concerning linkages between their programs and other programs in this study. Responses to both questionnaires are presented in tabular form. The study was expanded to study the impact of integration upon service delivery in a local area. Oachita Parish was . selected as the pilot because it is typical of the State, and local officials recognized a need for change in the social service delivery system. Program personnel surveyed concluded that their programs need to be more closely linked with other human service programs. The consumers surveyed also indicated a need for further coordination of services. Possibilities for coordination under the Allied t Services Act and/or within the present framework are discussed. A proposed coordination model is included. 16 APPENDIX IV APPENDIX IV Devils Lake Comprehensive Human Services Center. Denver University, Colorado. Center for Social Research and Development. 15 Mar 75, 98p Executive Summary available from PROJECT SHARE. SHR-0000336 Available from PROJECT SHARE, $5.00. A comprehensive humanservices project was sponsored by the Social Service Board of North Dakota to demonstrate that a concerted approach to service delivery can be effectively implemented in rural settings through an integrated, multi-purpose delivery system with satellite centers. The Devils Lake Comprehensive Human Services Center project in North Dakota served a large and sparsely . populated six-county rural area which included two Indian reservations. The concept of services integration for the Devils Lake Project is assessed, with emphasis on integrating linkages. The service delivery system is evaluated in terms of core service functions, direct services, client pathways, and services provided. Policy- making and planning are also evaluated, and consideration is given to the identification of community service needs and problems, policy planning and decision-making, program development, and other relevant developments in the State of North Dakota. Management considerations and operations associated with the Devils Lake project are detailed, including the management process, community relations and public information, staff development and training, and building facilities and services. The management informa- tion system developed during the course of the project is described and its effectiveness is evaluated. An appendix to the report outlines an evaluation methodology whose goal was to ascertain the extent to which the Devils Lake Project accomplished its immediate and long-term objectives. 17 APPENDIX IV APPENDIX IV Devils Lake Comprehensive Human Services Center. First Annual Evaluation Report. Section 1115 Research and Demonstration Project. Denver University, Colorado Center for Social Research and Development. 26 Mar 73, 139p Executive Summary available from PROJECT SHARE. PB-239 948 Available from NTIS, PC$6.OO/MF$2.25. The Devils Lake Comprehensive Human Services Center, a project serving five sparsely populated rural counties of the Lake Region of North Dakota is evaluated for a one-year period encompassing the total planning phase (January-June 1972) and an initial period of operations. The project serves an area of 6,670 square miles through its main office and four satellite offices, one of which is located on one of two Indian reservations in the service area. Some 32 separate agencies or groups are affiliated with the Center, including branches of the State Employment Service , Agricultural Extension Service, Bureau of Indian Affairs, and law enforcement agencies. The primary mode of agency interaction is voluntary cooperation between public and voluntary agencies, and the primary mechanism for achieving cooperation is an inter- agency State Project Board. The harmonious nature of interagency relationships that existed prior to initiation of the Project is considered a definite asset. The first section of the report describes the analytical framework of the project, with emphasis on integrating linkages and techniques as they relate to Project administration and to direct service provision. Major findings and recommendations are presented with respect to policy, planning, and decision-making; the State Project Board; Federal involvement; integrating structure, leadership, and management at the regional and local levels; the service delivery system, core services, and program structure: and support systems, including the integrated management and data information system. Part II of the report analyzes in depth each of these areas and draws conclusions relative to the level of services integration achieved by the project and barriers to services integration. The appendix presents a summary of the projected evaluation plan for the second year of operation. Twenty-eight tables accompany the text. APPENDIX IV APPENDIX IV Devils Lake Comprehensive Human Services Center. Second Annual Evaluation Report. Denver University, Colorado. Center for Social Research and Development. 15 Mar 74, 94p Executive Summary available from PROJECT SHARE. PB-239 949 Available from NTIS, PC$5.OO/MF$2.25. The activities of the Devils Lake Comprehensive Human Services Center, an integrated services demonstration project serving six rural counties of the Lake Region of North Dakota, are evaluated. The report covers the Center's second year of operation. Section I presents the major findings and conclusions of the evaluation, and identifies major barriers, obstacles, and problems relative to policy- making and planning, administration organization and management, service delivery, and support systems. Among the problems noted are the following: slow development of the program planning aspect of the Project; lack of an overall plan of action for the Project: fear of loss of autonomy by agency officials; lack of clear Federal definition of services integration; lack of clarity on the concept of voluntary participation and cooperation in the Project; operating problems with county welfare depart- ments: Federal programs and regulations which limit flexibility of State and local agencies in integrating services delivery; and lack of a precise definition and general understanding of the regional management information system. Section II discusses Project goals and accomplish- ments, actual and potential integrating linkages, problem identification, and policy planning and decision-making. Section III examines the administrative organization of the Project, relationships within the Project, and the management process. In Section IV, core service functions, direct services of participating agencies, and other service resources are described and their effectiveness is evaluated. Section V analyzes the management information system, staff development and training, community relations and public information, and building facilities and services of the Project. Appendices present a summary of a survey of integrating linkages undertaken as part of the evaluation, as well as supporting tabular data. 19 APPENDIX IV APPENDIX IV Evaluation of the Bus Transportation System (The Lift Line) of the Comprehensive Services Delivery System of the Department of Health and Rehabilitative Services. Florida State Dept. of Health and Rehabilitative Services, Tallahassee. Bureau of Research and Evaluation. 30 Aug 73, 88p SHR-0000495 Available from PROJECT SHARE, $5.00. Lift Line, a social service-oriented bus transportation system established in Palm Beach County, Florida as a two- year pilot project, is described and evaluated. Lift Line was initiated by the comprehensive services delivery system project to investigate the feasibility of implementing such a system on a permanent basis. Central findings of the evaluation are: (1) use of the Lift Line increased from 3,352 trips in October 1972 to 13,263 trips in June 1973; (2) in the opinion of service providers involved, Lift Line enables physically disabled clients and others in need of transportation to seek and obtain necessary social, medical, and training services; (3) the rural indigent and the elderly poor and disabled are particularly benefited by the service; (4) Lift Line operation cost is 48 cents per bus mile; and (5) the estimated cost savings due to Lift Line for June 1973 was $14,868, representing the difference between cost of Lift Line operations and the estimated costs of alternate modes of transportation that would have been incurred by Lift Line passengers. The Lift Line service and the problems it is intended to alleviate are described in detail. Continuation of the service beyond the pilot period is recommended. Supporting cost data, routes and schedules, and utilization statistics are included. Copies of questionnaires used to survey local government and private agencies concerning Lift Lines are provided. 20 APPENDIX IV APPENDIX IV Evaluation to Determine the Effectiveness of Coordination, Administration, and Delivery of Services by a Multi- Service Center in Rural America. Arkansas State Dept. of Social and Rehabilitative Services, Jonesboro. 1973, 121p. Executive Summary available from PROJECT SHARE. PB-240 390 Available from NTIS, PC$5.25/MR$2.25. The first year of operation of a multiservice center to deliver comprehensive social services in rural Arkansas is evaluated in this research report by the University of Arkansas. Despite some movements toward collaboration among organizations, at this point the Arkansas Services Center is really a collection of agencies housed in the same building rather than an effective multiservice organization with a service delivery system to provide consumers with integrated service. Suggestions regarding comprehensive social services include: appointment of an overall administrator with limited authority and responsibility working with an advisory- council: establishment of a management information system: establishment of a community relations board, rearrangement of geographic service areas to be coterminous; establishment of satellite centers to provide regional integration of services; provision of a central reception service supervised by a reception counselor; and preparation of a planned and structured staff development program for executive administrators and key and supervisory personnel. Other aspects of the report concern historical perspectives, the constituent organizations in the center, and the community image of the center. A survey of consumer attitudes is included which indicates general satisfaction with the services offered. 21 APPENDIX IV APPENDIX IV Evaluation of District V Health and Social Services Integration Project Through June 1974. FiveCounty Association of Governments, Cedar City, Utah. Sep 74, 157~ Executive Summary available from PROJECT SHARE. SHR-000033 Available from PROJECT SHARE, $6.75. An evaluation of the Health and Social Services Integration Project administered by the five County Association of Governments, representing Beaver, Garfield, Iron, Kane, and Washington Counties, Utah, is presented. The project, undertaken to demonstrate innovative approaches to services integration in an area which incorporates isolated, rural communities, uses tile Five County Association as the general purpose government integrator and management authority. Following an introductory description of the purpose and methodology of this evaluation, Chapter II discusses the philosophical concepts, objectives, system development, and circumstances impacting on accomplishment of tasks relative to the health and social service delivery system. Chapter III analyzes the impact of the policy-making and recommending bodies and the administrative structure relative to management, coordination, community relations, and research, planning, information, and evaluation. Chapter IV presents a cost analysis of the Utah system and of a comparable system, the Kearns Family Life Project; both projects were designed to test the concept of Master Service Units connected to coordinated and co-located service agencies. Chapter V considers the impact of the system on availability and continuity of services and on accountability to the Association of Governments. Chapter VI evaluates the system to date from the points of view of consumers, service providers, members of the Health and Social Services Council, and members of the project's Steering Committee. Chapter VII presents surmnary statistics of services provided as of June 1974, and the final chapter offers conclusions and recommendations. Appendices document evaluative surveys of service providers and committee and council members. 22 APPENDIX IV APPENDIX IV Evaluation of the Comprehensive Service Delivery System Project. Florida State Dept. of Health and Rehabilitative Services, Tallahassee. Bureau of Research and Evaluation. 15 Jan 74, 73p SHR-000050 Available from PROJECT SHARE, $4.50. A Comprehensive Services Delivery System Project, under- ' taken from 1970-1974 by the Department of Health and Rehabilitative Services, State of Florida, is evaluated. The Project involved the integration of human services in Palm Beach County, Florida, and incorporated the following goals: development of a multi-service delivery system to include comprehensive exploration and assignment for services, comprehensive multi-disciplinary service planning, utilization of selected services, and follow-up; improved organizational resource utilization: development of a preventive services program to minimize unmet health and rehabilitative needs in the project area: and development of a system to identify and evaluate community problems as the basis for the services system response to these problems. Descriptions and evaluations are present for the following project components: vocational assessment program, referral activities, staff training activities, regional council development, bus transportation system, client information system prototype, and quality assurance monitoring system. A case study follows a 21-year-old black female paraplegic through the system for three years. Costs involved for serving that one client are analyzed. Criteria used in evaluating the project included: assessment of original objectives; administrative cost saving; quality of service, i.e., impact on client; benefits of individual services innovations; and Federal guidelines. Evaluation procedures are described. Administrative and direct service linkages within the project are presented. The report is presented in an outline format, and includes numerous tables, flow charts, and budgetary analyses. 23 APPENDIX IV APPENDIX IV Evaluation of the Waianae-Nanakuli Human Services Center. Volume I. Summary and Recommendations. Hawaii State Office of the Governor, Honolulu. Services Integration Targets of Opportunity Project. 15 Jul 74, 77p Executive Summary available from PROJECT SHARE. PB-238 501 Available from NTIS, PC$5.OO/MF$2.25. As the first in a three-volume evaluation of the human services integration effort at the Waianae-Nanakuli Human services Center SIT0 (Services Integration Targets of Opportunity) Project, this document summarizes the history of the project and the findings and recommendations which emerged from the evaluation study. The Waianae-Nanakui center is part of a program based on a modified one-stop neighborhood service center concept; the program was formulated during the late 1960's and initially implemented in January 1970 as a component of the Progressive Neighborhoods Program. The Waianae-Nanakuli is one of four centers in Hawaii, and consists of four teams located in the elementary school of each of the communities on the Waianae Coast of Oahu; in addition, a central office houses the center manager and support staff. The SIT0 project was initiated in July 1972. Volume I outlines the following aspects of the Waianae-Nanakuli experience: initial pla;lning; activation: project expansion: linkages problems: administration development and information systems design: Technical Planning Committee and SIT0 planning; initiation of SIT0 project: responses to HEW Task Force recommendations following initial site visit in September 1972; reprogramming of SIT0 project: implementation of linkages by SITO; personnel conflicts: transfer of income maintenance unit; development of job descriptions and Service Center handbook: development of case management system; and others. Statistical data concerning the project's target group are summarized. The administration and planning and evaluation aspects of the project are assessed briefly, and short-range and long-range recommendations for the project s are presented. Organizational flow charts are included. 24 APPENDIX IV APPENDIX IV Evaluation of the Waianae-Nanakuli Human Services Center. Volume II. Process Evaluation. Hawaii State Office of the Governor, Honolulu. Services Integration Targets of Opportunity Project. 15 Jul 74, 628~ Executive Summary available from PROJECT SHARE. PB-238 502 Available from NTIS, PC$16.25/MF$2.25. Volume II of the three-volume process evaluation of the Waianae-Nanakuli Human Services Center, administered by the Progressive Neighborhoods Programs, Governor's Office, State of Hawaii, covers the conceptual and organizational frame- work within which project development, implementation, and operation occurred. Program activities are described chronologically, spanning the period from 1967 to July 1972, when the evaluation component, SIT0 (Services Integration Targets of Opportunity) project, was established. Project activities conducted after SITO's activation also are described. Chapter I details the hisotry of the development and operation of the Waianae-Nanakuli Center, and summarizes the status of the service delivery project at the time the SIT0 component was introduced. The Center provides services through four teams located in the elementary school of each of the communities on the Waianae Coast at Oahu; in addition a central office houses the center manager and support staff. Chapter II covers the process by which objectives and coordination mechanisms impact upon project planning, budgeting, and evaluation. Chapter III describes the administrative structure of the Waianae-Nanakuli Center and of its parent organization (Progressive Neighborhoods Program), and traces the development of administrative linkages since the inception of the SIT0 project. The final chapter documents the project's structural characteristics as they relate to the four interdisciplinary teams which provide direct services. The discussion focuses upon the service delivery system and subsystems, intra-team relationships, case management, common case record, and training program. Many organizational diagrams and supporting documents are included. 25 APPENDIX IV APPENDIX IV Evaluation of the Waianae-Nanakuli Human Services Center. Volume III. Statistical Analysis. Hawaii State Office of the Governor, Honolulu. Services Integration Targets of Opportunity Project. 15 Jul 74, 210~ PB-238 503 Available from NTIS, PC$7.75/MF'$2.25. The third and final volume of the evaluation report on the Waianae-Nanakuli Human Services Center in Oahu, Hawaii, presents selected portions of data utilized in the SIT0 (Services Integration Targets of Opportunity) Project effort to improve the planning and administrative capacity of the Center by evaluating existing conditions and faci- litating changes including the development of a management information system. The goal of the SIT0 activity has been the implementation of the case management process within the interdisciplinary team approach to services delivery utilized by the Center. The first section presents data indicative of socio-economic changes in the Center's target population on the Waianae Coast. These data are useful in planning the placement of community service centers, the mix of services to he provided, and the response of Center man- agement to patterns of community changes. The second section presents service utilization data for income maintenance, social services, public health services, employment ser- vices, and vocational rehabilitation services. These data reflect problems involved in using statistics gathered by different programs for different reasons in making decisions relative to resource allocation. Section III data represent the first attempt to measure multiple service cases in the Center: this initial multi-service case count, taken from December 1972 to November 1973, shows the results of collocation without a case management process in operation. The final format of the Center's Common Index File (CIF) System statistics report also is presented. Tabular data, a copy of the Center's handbook, and extensive documentation of the CIF system are included. 26 APPENDIX IV APPENDIX IV Human Service Development Programs in Sixteen Aliied Services (SITO) Projects. Human Ecology Inst., Wellesley, Mass. May 75, 396p Executive Summary available from PROJECT SHARE. SHR-0000058 Available from the Human Ecology Institute, 10 Babson Park Ave., Wellesley, Mass. 02157, $13.90. Human service development programs in 16 Allied Services Research and Demonstration Services Integration Targets of Opportunity (SITO) projects are described in the context of a development model incorporating the following elements: definition, design and pilot test, acquisition and installation, and trial operation. Objectives of the 1975 onsite survey were: to determine the current nature of development among the projects; to assess effects of development; to identify useful technology of development; to determine whether other models were being used successfuily; and to establish what must be done to improve human service development. A summary of findings and implications and detailed report for each site are presented. It is noted that, while new mechanisms for human service integration at the community or substate level have resulted from the SIT0 projects, it is the piecemeal nature of human service development in SIT0 that leaves the strongest impression, SIT0 sites include: Arizona Department of Economic Security; Brockton Area Human Resources Group, Inc., Massachusetts: Urban Management Information System, Chattanooga, Tennessee: Services Integration Project, Contra Costa County, California; North Central Alabama Regional Council of Governments; Devil's Lake Human Services Center, North Dakota; Community Life Association, Hartford, Connecticut; Department of Social and Rehabilitative Services, Jonesboro, Arkansas; Human Services Coordination Alliance, Jefferson County/Louisville, Kentucky; Michigan Office of Executive Assistant for Human Services; Minnesota Office of Program Development; Mon Valley Health and Welfare Council, Pennsylvania; Integrated Services Program, Polk County, Iowa; Virginia Division of State Planning, Human and Community Affairs: Nyssa Service Center, Treasure Valley, Oregon; and Five County Association of Governments, Cedar City, Utah. Survey methodology and forms are included. 27 APPENDIX IV APPENDIX IV Human Service Reform: A Case for Capacity Building. Minnesota University, Duluth. Department of Sociology and Anthropology. Jul 75, 68p SHR-0000294 Available from PROJECT SHARE, $4.50. The Office of Program Development (OPD) project in Minnesota, which was funded by the U.S. Department of Health, Education, and Welfare Services Integration Target of Opportunity (SITO) funds, is described. The effect of the project on Minnesota's capacity to influence information gathering, planning, resources allocation, and delivery processes is examined. Observations regarding the approach used by the OPD project and the implications that the approach has for human services reform are examined. The approach or strategy used by OPD to effect change in the human services system of Minnesota was to involve those who were inmediately affected by changes, either as implementors or by the overall effect of the implementation. The basis of this approach is that structural changes in the human services system will be more enduring and rational if the changes are preceded by a period of discussion and preparation. The OPD strategy is characterized as an interactive rather than unidirectional approach. Capacity building, according to the OPD project, is generally represented by structural changes that are related to the development and implementation of policy. Among such changes are the Human Services Act and the Office of Human Services. In addition to facilitating changes, the OPD project has provided insights into the change process and has provided a focal point for human service reform in Minnesota. Appendices to the report include a list of project interviewees, an analysis of project activities, and project outputs. 28 V APPENDIX IV APPENDIX IV Integrating Human Services. Volume I. Touche Ross and Co., Portland, Oregon. Mar 74, 117~ Executive Summary available from PROJECT SHARE. SHR-0000245 Available from PROJECT SHARE, $5.50. The findings of a review of the Oregon State Department of Human Resources (DHR) and an analysis of feasible alternatives for integration of service delivery to Oregon citizens are reported. The DHR is comprised of the following divisions: employment security, public welfare, children's services, mental health, health, corrections, vocational rehabilitation, and special programs. The analysis resulted in recommendations for organizational strategies and systems to improve the following major aspects of service delivery: accessibility by needy clients to services offered by the department; timeliness of services with respect to client needs: appropriateness of services to satisfaction of systematically defined client problems and objectives; effectiveness of services in accomplishing defined-services objectives relative to individual clients and Oregon society as a whole; and administrative visibility and control over the service delivery process and supporting activities. The following major recommendations are offered: (1) implement a common program structure as a basis for ongoing planning, evaluation, and management of DHR services: (2) establish a DHR central staff organization that is workplan-oriented and that emphasizes resolution of interdivisional issues; (3) develop an integrated system for intake and case management related to DHR restorative services that may be administered in a standard fashion by existing division professional staff; (4) establish eight common DHR geographical regions; (5) establish eight DHR field coordinator positions; and (6) develop indepth training programs for DHR field coordinators, division professionals, and the general public. A phased program for implementation of the recommendations is presented. A description of study methodology, overview of existing department organization, and organizational flow charts are included. 29 APPENDIX IV APPENDIX IV Integration of Human Services in HEW. An Evaluation of Services Integration Projects, Volume I. Marshall Kaplan, Gans, and Kahn, San Francisco, California. 1973, 179p Executive Summary available from PROJECT SHARE. SHR-000127 Available from PROJECT SHARE, $7.50. An examination of more than 30 services integration projects to determine which factors lead to the integration of social services is reported. The projects studied were classified in two ways: according to project characteristics such as organizing principle for service clustering, mode of client entry, organizational sponsorship, and mode of cooperation: or according to type of integrating linkage. Case studies were developed for each project based on reviews of documents and structured interviews with project personnel. The study reveals that integration of services is not extensive and that a wide range of factors facilitates and inhibits services integration. Services integration was found to result in improved accessibility, continuity, and efficiency, but there is no single best services integration model. Recommendations to promote services integration include creation of an environment conducive to integration, elimination of internal HEW constraints, and building services integration into the HEW grant system. Inhibitors and facilitators of services integration are categorized and ranked according to impact. Several directed coordination projects are described and compared, as are voluntary coordination projects. A list of the projects studied is appended. 30 APPENDIX IV APPENDIX IV Integration of Human Services: The State and Municipal Levels. Sheldon P. Gans and Gerald T. Horton. Marshall Kaplan, Gans, and Kahn, San Francisco, California. 1975, 363~ SHR-0000485 Available from Praeger Publishers, 111 Fourth Avenue, New York, New York 10003, $21.50. The nature and progress of human services integration is evaluated based on a 1972 study by Marshall Kaplan, Gans, and Kahn and the Research Group, Inc., two private consulting firms. The study examined over 30 human service delivery projects nationwide to determine which factors lead to the integration of social services. Case studies developed for each project provide the basic information for the evaluation. The major findings of the study indicate that integration of services is not extensive and that services integration is an evolutionary process. The following factors can facilitate and/or inhibit integration: the socio-political environment, project objectives and priorities, project director and staff, service provider objectives and attitudes, and grant administration policies and procedures. It was concluded that there is no one best services integration model. Comparative analyses of the projects are provided and the range of integrating linkages which can be developed between separate agencies are discussed. A critique of the 1972 Allied Services Act is presented based on the experiences of six States. This analysis examines the extent to which each of the six States have consolidated human service functions in a single organizational entity: the extent to which States have developed a multifunctional planning and programming capacity; the extent to which States have decentralized the service delivery system to uniform substate districts; and the extent to which States are structured to provide the coordinated service delivery of programs covered by the Allied Services Act. 31 APPENDIX IV APPENDIX IV Present Status and Future Directions of the Human Services Planning and Coordination Project. Maryland Dept. of State Planning, Baltimore. Dee 74, 75~ Executive Summary available from PROJECT SHARE. SHR-000085 Available from PROJECT SHARE, $4.50. The status of the Human Services Planning and Coordination Project of the Maryland Department of State Planning, designed to provide a framework for reviewing and analyzing services needed by Maryland citizens, is assessed. A study design for the Project was developed by a committee of persons representing Federal, State, local, and regional agencies; nongovernmental agencies provided input and continue to participate. The Human Services Task Force was formed to provide information, review reports, and provide liaison with State, regional, and local agencies. A classification scheme for analysis of need and resource information based on an activity sector/target population framework was devised. This framework also serves as a method for categorizing information. An inventory of all State human service programs was compiled and agency interviews were conducted to determine current departmental planning activities and the extent of interagency cooperation. Social indicators which can aid in the identification of need are currently being developed. Other aspects of the Project which are still in the developmental stage are involvement of the Executive Department in the planning process, information about volunteer services, identification of issues by activity sector, and an evaluation mechanism. Plans for 1975 include planning seminars and agency staff augmentation. The appendix contains the classification scheme and a roster of Task Force members. 32 APPENDIX IV APPENDIX IV Progress Report Services Integration. Richard Roessler and Greta Mack. Arkansas Rehabilitation Research and Training Center, Fayetteville. " Dee 72, 67p ARR and TC-734 PB-238 851 Available from NTIS, PC$4.5O/MF$2.25. Initial research on the effectiveness and the efficiency of an integrated human services system, plus the development ' of a model for integrated service delivery is presented in this report. At a pilot project at the Arkansas Services Center in Jonesboro, a staff of the Regional Integrated Services, (RIS) provides administrative direction for integration of all social and rehabilitative service agencies. The agencies are not merged in any way, but the presentation of service is through a joint involvement of agencies in case planning. The report contains data on current efforts for services integration, RIS and client information flow, and RIS objectives. Research proposals for services integration include the incorporation of determining integration and client outcomes, i.e., does the client fare better under an integrated approach? Increasing the effectiveness of integration, and also of organizational efficiency and effectiveness are of prime importance. Other important considerations are involving the client in the management of his own case through close cooperation with the case manager, barriers to such client involvement, client satisfaction, problems and hypotheses, and variables and measures. Some early observations on integration efforts are presented. 33 APPENDIX IV APPENDIX IV Quality Assurance Monitoring in the Comprehensive Services Delivery System. Florida State Dept. of Health and Rehabilitative Services, Tallahassee. Bureau of Research and Evaluation. Apr 74, 188~ SHR-0000500 Available from PROJECT SHARE, $7.50. Findings of a survey of clients and professional staffs are documented concerning the quality assurance monitoring system study of the Department of Health and Rehabilitation Services (DHRS) facilities in Palm Beach County, Florida. The study was designed to assess the quality and delivery of DHRS services in a way which might be compared with concomitant measures of cost, benefit, effectiveness, and impact to provide a broad basis for periodic program evaluation. Specific objectives included identification of areas needing improvement in the quality of service, and the development of tools and expertise necessary to implement a statewide quality assurance monitoring system. Four separate survey instruments were chosen: (a) the facilities quality evaluation which consists of a site inspection (findings for this section are published separately); (b) take-home client opinion sheets: (c) in-depth client interviews conducted in the homes of a randomly-selected sample of clients; and (d) professional. staff evaluation. Generally, findings indicate that clients and professionals tend to respond favorably to questions concerning the quality of DHRS services, and both groups respond more favorably to depart- mental services than to departmental facilities. Clients produced a fairly uniform positive response concerning their agency contacts, with the exception of questions concerning clients' rights. Negative client responses are particularly indicated in the area of services for which the client is eligible but was not informed. Tables and appendices present supporting data and survey instruments. This is CSDS Report No. 34. 34 APPENDIX IV APPENDIX IV Regional Councils Assessment and the Regional Coordinator. Florida State Dept. of Health and Rehabilitation Services, Jacksonville. Bureau of Research and Evlauation. May 74, 117~ SHR-0000503 Available from PROJECT SHARE, $5.50. The effectiveness of Florida State Department of Health and Rehabilitative Services (DHRS) regional councils in promoting the integration of regional services at the local ' level is assessed. Based on the successful experience of experimental regional councils in promoting integration of regional agencies at the local level, a statewide network of 11 DHRS regional councils was developed to provide a mechanism for cooperation and coordination among DHRS agencies within regions. Responses to questionnaires sent to all council members indicate a lack of accomplishment on the part of the councils. Inadequate time devoted to council meetings and limitations upon council chairmen as coordinators of council activities are cited as factors in constraining the initiation and carrying out of council activities. The organizational need for a regional coordinator as opposed to a regional council chairman is discussed, and the role of such a regional coordinator is considered. The report draws on the experience of one regional administrator working on a pilot basis in one region to describe what the coordinator's position could entail. Establishment of the regional coordinator position within the Department is recommended on the basis of the need for a permanent position, an unbiased mediator, a single department representative, a departmental approach in multiservice case problems, and consolidation of certain regional administrative functions. 35 APPENDIX IV APPENDIX IV Rural Human Resources Project of the Association of County Commissions of Alabama. Annual Report. Year One, July 1, 1974 through June 30, 1975. .R. Hugh Lasseter. Association of County Commissioners of Alabama, Montgomery. 1975, 47p- - Executive Summary available from PROJECT SHARE. SHR-000090 Available from PROJECT SHARE, $4.00. Findings of a study of the human service delivery system in the ten county rural Alabama-Tombigee Rivers Regional Plan- ning and Development Commission area are presented in this annual report: the project is part of the larger, eight-state Rural Human Resources Project. Staff directors, personnel actually engaged in delivery of services, and elected county officials were interviewed, in addition to a limited number of recipients encountered in different agencies. Though many agencies had problems unique to their own operations, many problems and needs were identified as common to the entire target area. These include: transportation: motivation: alcoholism: inadequate staff; lack of emergency funds; lack of hospital chaplaincy; ineligibility for social security: short- age of funds; lack of coordination between agencies: poor public , relations: inadequate mechanisms fox staff input into the system; need for a centralized information and referral service; administration of food stamp program: youth project loans; and failure of work incentive program. Recommendations for the on-going project include improvement in coordination; establishment of a suggestion system and awards to promote staff inputs; development of a centralized information and referral service: and a reorganization of the work incentive program. Other recommendations are included as well as descriptions of project-sponsored activities. 36 APPENDIX IV APPENDIX IV Second Year Evaluation Report of the East Cleveland Community Human Serv ices Center. R. 0. Washington, Mel Karmen, and Allan Friedlob. Case Western Reserve Univ., Cleveland , Ohio. Human Services Design Lab. 15 Feb 74, 202~ Executive Summary available from PROJECT SHARE. PB-240 738 Available from NTIS, PC$7.75/MF$2.25. The East Cleveland Community Human Services Center, a Federally funded demonstration project experimenting with new ways to deliver integrated social services to the poor and near poor, is evaluated in its second year of operation. The report attempts to assess the concept of services integration as well as the performance of the East Cleveland Project as a prototype. Following an introductory discussion of human services integration, Chapter II focuses on the his- tory of the Cleveland Project. The Project incorporates a number of innovative features, such as services contracts with consumers, provider contracts with agencies, and use of a management information system. Sponsored and managed by the municipal government, the Center provides information, referral, and follow-up services, and coordinates activities in the areas of health, housing, consumer education, transportation, delinquency prevention, and protection and maintenance of the elderly and disabled. Chapter III presents a comparative , analysis of activities in East Cleveland and in Highland Park, ' Michigan, with a view toward isolating factors which account for particular program outcomes in East Cleveland. Chapter IV examines the Center and its activities as a change agent, focusing on the Center's capacity to provide advocacy and brokerage services. Chapter V evaluates case management as a service delivery system, using the concept of adequacy of performance as the primary criterion. Chapter VI assesses the scope and impact of the East Cleveland Center as an integrator,, focusing on the coordination between the Center and service providers. Chapter VII presents a cost effectiveness analysis of the transportation component of the Senior Citizen Activities Center and offers recommendations for improving that operation. It is concluded that a viable services integration system utilizing case management as the primary mode of service delivery must create in the community a social service marketplace. To do this, the system must have purchase-of-service capacity and organizational clout. Tables and a bibliography are included; 37 APPENDIX IV APPENDIX IV Service Identification System-- A Transferrable Model. Integrated Services Program, Polk County/Des Moines, Iowa. 4 Apr 74, lop SHR-000046 Available from PROJECT SHARE, $3.50. A model of a Service Identification System (SIS), a tool used to establish a Resource Inventory of service provider information in Polk County, Iowa, is described. A matrix-type questionnaire inventory developed by the Secretariat of the Integrated Services Program, which was submitted to 236 Human Service Agencies, permits correlations between agency services and client needs and wants in relation to barriers to an individual's self-sufficiency. This information is then correlated with client eligibility criteria. A review of existing literature provides the Secretariat with experiences of others in similar endeavors. All data is then organized into one overall system consisting of a central data base. Data are arranged into five fields: barriers which inhibit attainment of self-sufficiency, agency identification and description of problems, client problems, type of service needed to alleviate these problems and barriers, and client eligibility criteria. Results have produced a mutually exclusive, unduplicated list of 1,100 agency services and 900 client problems. Conversion tables are being written to make ' the SIS more transferable and to interface with existing soft- ware systems. A service plan, essentially a contract entered into by the client, case manager, and service provider, provides a means of problem resolution. It is through the service plan that a plan of action is established, services are requisitioned, program specifications are written, client activity is reported, and reassessment follow-up and case evaluation is accomplished. The appendix is comprised of transactional tables and the Inventory of Human Resources Questionnaire. 38 APPENDIX IV APPENDIX IV Services Integration. Part I. Site Reports. Barbara C. Sampson. ABT Associates, Inc., Cambridge, Mass. Dee 71, 168~ Executive Summary available from PROJECT SHARE. SHR-000063 Available from PROJECT SHARE, $6.75. Project status reports, based on on-site visits to 12 services integration projects funded by the U.S. Department of Health, Education, and Welfare in FY 1971, are presented. Each report describes the following aspects of the project: organization, staffing, budget, progress to date, design of the information system, status of the evaluation design, problem areas, and future plans. The following projects are included: (1) Anacostia, Washington, D.C., a human services integration project within the Department of Human Resources: (2) Augusta, Maine, development of planning capabilities within State human services agencies; (3) Augusta, Maine, development of State Social Services Delivery System; (4) Boston, Massachusetts, capacity building in services integration; (5) Devil's Lake, North Dakota, development of the Devil's Lake Comprehensive Human Services Center; (6) East Cleveland, Ohio, operation of the East Cleveland Community Human Service Center: (7) Glasgow, Montana, operation of the Montana Rural Social Service Delivery System; (8) Howard County, Maryland, demonstration of a comprehensive multiservice center in a rapidly urbanizing rural county; (9) Lansing, Michigan, Model Cities planning demonstration; (10) New York, New York, decentralization and service integration project; (11) Olympia, Washington, the regional integration component of a human services delivery integration development and evaluation project; and (12) Seattle, Washington, the "Skid Road" component of the human services delivery integration development and evaluation program. 39 APPENDIX IV APPENDIX IV Services Integration. Part II. Integrating Techniques. Barbara C. Sampson. ABT Associates, Inc., Cambridge, Mass. Dee 71, 89p Executive Summary available from PROJECT SHARE. SHR-000064 Available from PROJECT SHARE, $5.00. Common integrating techniques identified among 12 services integration projects funded by the U.S. Department of Health, Education, and Welfare in FY 1971 are defined, and the specific techniques utilized by each project are outlined. The inter- grating techniques identified are: (1) co-location of services; (2) shared core service functions; (3) mechanism for information, referral, and follow-up; (4) agreements to provide complementary services; (5) joint funding; (6) target group advocacy; (7) noncategorical program administration; (8) coordi- nated program planning: and (9) leadership role for general purpose government. Non-categorical program administration is described as a technique for those projects which are both administered and operated by an umbrella agency. Mechanism for information, referral, and follow-up is identified as a technique either in projects having only information, referral, and follow-up functions, or in projects having these functions ' in conjunction with other service delivery activities. An initial series of charts presents definitions, descriptors, objectives, evaluation criteria, and data sources relative to each technique. The second series of charts details the utilization of these techniques by service integration projects undertaken in the following locations: Anacostia, Washington, D.C.; Augusta, Maine; Boston, Massachusetts; Devil's Lake, North Dakota; East Cleveland, Ohio: Glasgow, Montana; Howard county, Maryland; New York, New York; Olympia, Washington; Seattle, Washington; and the State of Maine. These projects represent human services integration planning efforts at State, county, and local levels, as well as demonstration projects involving human service centers operating in both rural and urban settings. 40 APPENDIX IV APPENDIX IV Services Integration. Part III. An Overview. ABT Associates, Inc., Cambridge, Mass. Dee 71, 42p SHR-0000160 Available from PROJECT SHARE, $4.00. In the third part of a 3-report series documenting an assessment of 12 services integration projects funded by the U.S. Department of Health, Education, and Welfare in fiscal year 1971, an overview is presented of project characteristics, strengths, and weaknesses. Five of the projects studied focused on county or regional areas, five on single urban areas, and two on entire States. Three were directed specifically toward rural servioe delivery concerns. Eight were actual service delivery pro- jects, and four were concerned primarily with capacity- building. Following a description of the projects and of their major components, the status of project information and evaluation efforts and the kinds of integrating techniques being employed by the projects are summarized. Project strengths are then pointed out relative to involvement of other resources, development of strong programs as part of reorganization efforts, development of noncategorical approach to service delivery, testing of innovative techniques, and commitment to the project. Similarly, weaknesses are identified relative to slowness of project startup, absence of skills required to fulfill project objectives, absence of program elements crucial to project success, tenuousness of support of sponsoring agency, lack of clear quantifiable objectives, and inadequacy of data. Recommendations are presented in the areas of communication, information dissemination, technical assistance, and evaluation for the projects investigated; further recommendations are offered with regard to criteria for selection of future services integration projects. Projects visited were located in Washington, D.C.; Augusta, Maine; Boston, Massachusetts; Devil's Lake, North Dakota; East Cleveland, Ohio; Glasgow, Montana; Howard County, Maryland; Lansing, Michigan; New York, New York; Olympia, Washington; Seattle, Washington; and the State of Maine. 41 APPENDIX IV APPENDIX IV Services Integration Progress Report. April-July, 1973. Richard Roessler and Greta Mack. Arkansas Univ., Little Rock. Rehabilitation Research and Training Center. Sep 73, 73p Executive Summary available from PROJECT SHARE. PB-238 958 Available from NTIS, PC$4.50/MF$2.25. Three activities of the Arkansas Rehabilitation Research and Training Center conducted during a three month period are described in this interim report. The activities included measuring social agency client satisfaction, an experimental approach to case management, and a pilot study of the operation of the Committee of Agency Specialists. In addition, the report lists consulting and proposed future activities. Findin,gs indicate that the survey instrument used to measure client satisfaction was an acceptable method, and that clients are satisfied with their service programs, with the exception of two needs expressed by clients which might be improved by services integration; these included better information regard- ing other sources of help, and improved screening so that other family members can receive immediate services. Several recommendations were made to improve the new approach to case management; these included initial screening by case managers, focus on family units, and an increase in utilization. Follow-ups with the survey instrument will provide valuable comparisons with those in the present survey. 42 APPENDIX IV APPENDIX IV Services Integration: The Evaluation of the Service Integration Project of the Human Resources Planning Coalition of Greater Duluth, Incorporated. William A. Fleischman. Minnesota Univ., Duluth. Dept. of Sociology and Anthropology. Jun 73, 112~ Executive Summary available from PROJECT SHARE. PB-239 783 Available from NTIS, PC$S.SO/MF$2.25. The use of coalition as the prime vehicle for human ser- vices integration is examined in this evaluation of the Service Integration Project of the Human Resources Planning Coalition (HRPC) of Greater Duluth. The projects developed represent the Coalition's effort to fulfill five primary functions: (1) coordination of and among planning agencies and service delivery agencies; (2) planning for filling gaps in services and for improvement of existing services (includ- ing formulating policy and assisting with implementation); (3) provision of technical assistance to agencies in the areas of administration, planning, data collection, and evaluation; (4) provision of data base/information system support; and (5) evaluation of the efficiency and effectiveness of programs. The evaluation of the Project was based on interviews with HRPC staff, directors, and Board members, and with personnel of the participating agencies. Results of the evaluation indicate that a voluntary coalition such as HRPC has little potential for assuring the coordination'of agencies. Factors accounting for the low impact of the coordinating efforts of HRPC are discussed, and two alternative models to the voluntary coalition are proposed. General discussions of the service integration concept and process are provided. The five projects described and evaluated are: Manpower Project, Youth Devedopment Project, Public Assistance Vocational Rehabilitation Project, Human Development Center and Family Services Project, and Aging Project. Appendices include the evaluation instruments, Community Services Survey Recommendations, and excerpts from HRPC bylaws. 43 APPENDIX IV APPENDIX IV Supplement to Human Services Integration: State Functions in Implementation. Council of State Governments, Lexington, Kentucky. Ott 74, 372~ SHR-0000468 Available from PROJECT SHARE, $10.50. The findings of an investigation by the Council of State Governments into the status of services integration in 20 States are summarized. The States studied during 1973 and 1974 included: Arizona, Arkansas, California, Delaware, Florida, Georgia, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregonp Pennsylvania, Texas, Utah, Washington, and Wisconsin. Each summary provides a brief overall view of the status of integration followed by background information on the organization or reorganization of the services integration effort in the State, and any unusual or noteworthy arrange- ments for organization or reorganization. Accomplishments and problems are notedp as is information on regionalization of services where it occurs. A flow chart of the State organizational structure, a discussion guide and analytical framework which provides detailed data on the comprehensive statewide planning agency and its linkages with regional agencies, obstacles to services integration, and methods used for services integration are presented. A list of interviewees in each State is presented. Supplementary material is available in SHR-0000003. 44 APPENDIX IV APPENDIX IV Survey of Service Integration. HarbridgeHouse, Inc., Boston, Massachusetts. Jul 72, 73p SHR-0000505 Available from PROJECT SHARE, $4.50. Findings are presented of a survey of State and local government and service agencies, and representatives of private organizations to determine the perceived need for ' human services integration, the obstacles to integration, and strategies to overcome the obstacles and to achieve improved coordination. The survey covered five States and 12 localities within those States and involved 221 inter- views. Two topics, planning for service integration and establishing an administrative framework for service integration, were selected for in-depth study, and these results are furnished separately. Findings and conclusions are grouped into three major categories: (1) service integration as a priority in relation to other domestic objectives and to other means of improving services; (2) priorities in service integration in terms of obstacles/ problems and strategies/solutions; and (3) planning and implementing service integration in terms of strategy and tactics, problems and solutions, and roles and functions. It was determined that service integration, particularly in the sense of structural change in the delivery system, is not generally seen as a high priority in comparison of other domestic needs, and that improvement in services delivery might equally well be achieved by emphasizing other strategies. Problems in organization and management are seen as the principal obstacles to coordinated delivery, and several changes in intergovernmental and interagency relations are identified as a means of overcoming the problems. 45 APPENDIX IV APPENDIX IV Survey of Service Integration Case Studies and Anecdotal Data. Harbridge House, Inc., Boston, Mass. Jul 72, 73p Executive Summary available from PROJECT SHARE. SHR-000017 Available from PROJECT SHARE, $4.50. Case studies of six human service integration efforts in Massachusetts are presented, together with two reports illustrative of the problems and failings of human service delivery as experienced by two individuals--a woman blinded in an accident and a juvenile drug abuser--who required services but had difficulty in obtaining them. The case studies describe the following: (1) coordination of comprehensive health planning and regional medical programs in Massachusetts'; (2) development of a coordinated Statewide network of child care and child development services: (3) an attempted State-level agency merger, combining the State Department of Health and Social Services with the State Department of Institutions to establish a new Department of Human Services; (4) efforts to establish a centralized local planning and information and referral organization, document- ing a failed attempt by a national systems consulting firm under contract with the Model Cities Administration to develop . a computerized information system for human service agencies in a Massachusetts metropolitan area; (5) establishment of a program of social services for public housing tenants under a purchase-of-service agreement between the State Department of Social Services and the Boston Housing Authority; and (6) establishment of a unified service delivery system by the State Department of Health and Social Services. The document also presents illustrative anecdotes and comments obtained during interviews for preparation of this report, relative to social, political, and economic factors in service integration; legislative and administrative factors; organization and management factors; and delivery factors. 46 APPENDIX IV APPENDIX IV Twenty-two Allied Services (SIT01 Projects Described as Human Service Systems. Stephen D. Mittenthal, John Clippinger, Hans-Jochen Gotzman, and Rebecca T. Dixon. Human Ecology Inst., Wellesley, Mass. May 74, 441~ Executive Summary available from PROJECT SHARE. PB-240 001 Available from NTIS, PC$11.75/MP$2.25. Twenty-two Allied Services SIT0 (Services Integration Targets of Opportunity) projects are described as human service systems, within the context of a loop model which incorporates the following structural elements: (1) a set of community members to be served by the system: (2) system governance: (3) an effect specification: (4) a system manager: (5) the system itself, which acts on clients to produce specified effects: (6) an audit of effects achieved; and (7) funding of the operating system. The report is designed to provide information about human service system development and operatior The operating community-level human service system is considered in its relationship to the community to other systems, to higher levels of governance, to individual clients, and to system development; each key internal feature of an ideal operating system is discussed. SIT0 project reports are presented, and areas in which the projects fail to measure up to the ideals set forth in the model are identified. Prior to the individual reports , a summary offers an overview of all 22 projects. Reports are included for the following SIT0 project State or community sites: Anacostia, Washington, D.C.; Arizona; Brockton, Massachusetts: Chattanooga, Tennessee; Hartford, Connecticut; Jonesboro, Arkansas; Massachusetts: Minnesota; Mon Valley, Pennsylvania; New York City, New York; Utah; Contra Costa County, California; Decatur, Illinois: Des Moines/Polk County, Iowa: Devil's Lake, North Dakota; East Cleveland, Ohio; Glasgow, Montana; Louisville, Kentucky; Maine: Michigan; Richmond, Virginia; and South Dakota. The bulk of the document consists of the individual site reports. 47 APPENDIX IV APPENDIX IV ALPHABETIC LIST OF CORPORATEAUTHORS ABT Associates, Inc., Cambridge, Mass. Services Integration. Part I. Site Reports. Services Integration. Part II. Integration Techniques. Services Integration. Part III. An Overview. Alcohol, Drug Abuse, and Mental Health Administration, Rockville, Maryland. Arkansas Regional Services Integration Project. Period Covered July 1, 1972 through August 30, 1975. Arkansas Rehabilitation Research and Training Center, Fayetteville. Progress Report Services Integration. Arkansas State Dept. of Social and Rehabilitative Services, Jonesboro. Evaluation to Determine the Effectiveness of Coordina- tion, Administration, and Delivery of Services by a Multi-Service Center in Rural America. Arkansas Univ., Little Rock. Rehabilitation Research and Training Center. Services Integration Progress Report. April-July, 1973. Association of County Commissioners of Alabama, Montgomery. Rural Human Resources Project of the Association of County Commissions of Alabama. Annual Report. Year One, July 1, 1974 through June 30, 1975. Case Western Reserve Univ., Cleveland, Ohio. Human Services Design Lab. Second Year Evaluation Report of the East Cleveland Community Human Services Center. Council of State Governments, Lexington, Kentucky. Supplement to Human Services Integration: State Functions in Implementation. Denver University, Colorado. Center for Social Research and Development. Devils Lake Comprehensive Human Services Center. Devils Lake Comprehensive Human Services Center. First Annual Evaluation Report. Devils Lake Comprehensive Human Services Center. Second Annual Evaluation Report. Five County Association of Governments, Cedar City, Utah. Evaluation of District V Health and Social Services Integration Project Through June 1974. 48 APPENDIX IV APPENDIX IV Florida State Dept. or Health and Rehabilitative Services, Tallahassee. Bureau of Research and Evaluation. Assessment of CSDS Service Integration and Linkages. Comprehensive Services Delivery System (Its Nature and History). Lantana, Florida. Evaluation of the Bus Transportation System (The Lift Line) of the Comprehensive Services Delivery System of the Department of Health and Rehabilitative Services. Evaluation of the Comprehensive Service Delivery System Project. Quality Assurance Monitoring in the Comprehensive Services Delivery System. Regional Councils Assessment and the Regional Coordinator. Greater Hartford Process, Inc., Connecticut. Community Life Association from 1972-1975. Harbridge House, Inc., Boston, Massachusetts. Survey of Service Integration. Survey of Service Integration Case Studies and Anecdotal Data. Hawaii State Office of the Governor, Honolulu. Services Integration Targets of Opportunity Project. Evaluation of the Waianae-Nanakuli Human Services Center. Volume I. Summary and Recommendations. Evaluation of the Waianae-Nanakuli Human Services Center. Volume II. Process Evaluation. Evaluation of the Waianae-Nanakuli Human Services Center. Volume III. Statistical Analysis. Human Ecology Inst., Wellesley, Mass. Human Service Development Programs in Sixteen Allied Services (SITO) Projects. Twenty-two Allied Services (SIT01 Projects Described as Human Service Systems. Integrated Services Program, Polk County/Des Moines, Iowa. Service Identification System--A Transferrable Model. Louisiana State Governor's Office of Federal Affairs and Special Projects, Baton Rouge. Office of Human Services Planning. Coordination of Selected Human Services Programs. Marshall Kaplan, Gans, and Kahn, San Francisco, California. Integration of Human Services in HEW. An Evaluation of Services Integration Projects, Volume I. Integration of Human Services: The State and Municipal Levels. 49 APPENDIX IV APPENDIX IV Maryland Dept. of State Planning, Baltimore. Present Status and Future Directions of the Human Services Planning and Coordination Project. Minnesota University, Duluth. Department of Sociology and Anthropology. Human Service Reform: A Case for Capacity Building. Services Integration: The Evaluation of the Service Integration Project of the Human Resources Planning Coalition of Greater Duluth, Incorporated. Rand Corp., Santa Monica, California. Aggregating Organizational Experience With Services Integration: Feasibility and Design. Census of Local Services Integration. 1975. A Working Note. Touche Ross and Co., Portland, Oregon. Integrating Human Services. Volume I. 50 ,.. AN EQUAL OPPORTUNITY EMPLOYER UNITEDSTATES POSTAGE AND FEES PAID GEN9XALACCOUNTINGOFFICE U. S. GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE,$JOO THIRD CLASS
Transportation Programs for the Elderly
Published by the Government Accountability Office on 1977-04-07.
Below is a raw (and likely hideous) rendition of the original report. (PDF)