Service Integration

Service Integration and its Critics

The idea of integrating human services first gained popularity during the 1960s and 1970s, when the rapid growth of the human services industry led to a fragmentation of services for clients. Integration at the agency level, advocates believed, would lead to integration of direct services for individual clients, and this, in turn, would lead to better client outcomes. Service integration has been an elusive goal for planners and policymakers, however. Michael Lipsky (1980) pointed out that the unwritten policies of day-to-day service delivery can undermine efforts to improve the coordination of human services. Roland Warren and his colleagues (1974) argued that powerful social service institutions with vested interests in resisting change can thwart new approaches to improving service delivery. Janet Weiss (1981) argued that the symbolic value of coordination can distract attention from the political work of negotiation and compromise that is necessary to integrate service systems. Earlier, Warren also contended that even when service integration efforts are successful, they may have little long-term impact on social problems that are shaped by national economic trends or public policy (1973).

Key Service Integration Efforts and Research Findings

Deborah Dennis and her colleagues (1998) have provided a useful review of federally and privately funded service integration efforts for persons with mental illness or substance abuse problems, including those who are homeless. Five of these are outlined here. The first, cosponsored by the Department of Housing and Urban Development, is the HUD–Robert Wood Johnson Foundation Program on Chronic Mental Illness. This program funded efforts to develop local mental health authorities (LMHAs) to coordinate public-financed mental health services. Second are the homeless demonstration projects (to demonstrate the effectiveness or lack of effectiveness of a certain approach) funded by the McKinney-Vento Homeless Assistance Act, which aimed to coordinate outreach, case management, mental health and substance abuse treatment, and housing services for homeless persons. Third is the federal Health Care for the Homeless Program, which funds coordinated health care, outreach, and case management services for homeless individuals and families. Fourth is HUD's Shelter Plus Care Program, which requires that communities applying for housing certificates for homeless persons must provide matching support services. Fifth, since the mid-1990s, HUD has required that communities requesting funds for most of its homeless programs submit a “Continuum of Care” plan for developing a comprehensive, coordinated system of care for homeless persons.

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