oversight

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)

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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
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