Rethinking human service delivery: with a family focus.

Joe on Staten Island used it so his son would receive a nutritious lunch every day at school. Jill in the Bronx used it to discover that she qualifies for public health insurance. And the Jones family, after both parents got laid off, used it to help them get back on their feet. But none of them had to set foot in an office to get their benefits rolling.

Since 2006, residents of New York City have been able to research and prescreen for 35 different social programs through a single portal called ACCESS NYC. Thousands of charities also use the portal to help New Yorkers understand how these programs--including the Supplemental Nutrition Assistance Program (formerly known as "food stamps"), public health insurance and Earned Income Tax Credit--can help them.

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The portal is the product of the Integrated Human Services System Task Force, launched by Mayor Michael Blooberg in 2005. The goal of the task force: to determine how technology could enhance and streamline service delivery in order to make local government services more efficient and responsive to residents' needs. Historically, too many city agencies have gotten by with disconnected information systems, thus limiting their ability to coordinate and deliver the kinds of services their citizens require.

ACCESS NYC effectively offers a one-stop shop for a variety of city, state and federal programs. Instead of treating SNAP or Medicaid as disconnected services--when the reality facing the typical family is much more complex--the portal helps agencies work together to solve problems more quickly and completely. It is proving invaluable because so few local, state and federal services are able to coordinate their efforts.

In the U.S. health and human services sector in particular, the prevalence of "stovepipe" programs, each with its own bureaucracy, challenges already overworked caseworkers, who cannot access a big-picture view of all the benefits any one of their clients might be receiving. For example, say the Ramirez family is receiving housing assistance--temporary accommodation until the family is back on its feet--but their housing needs are approached in isolation. Hence they receive the first accommodations available, which unfortunately are on the opposite side of the city from their retraining and job site, as well as the physical therapy center where they take their physically impaired child three afternoons per week. As a result of having to travel so much, can they take full advantage of their training or reemployment programs? Might this cause them to take significantly longer to complete the programs, or struggle to complete them at all?

Across the U.S., the fallout from today's volatile economic situation has left many families scrambling for assistance from human services agencies--many for the first time in their lives. Yet with social program capacity stretching to breaking limits, too many human services in the U.S. remain disconnected, which is costly for governments--not to mention the citizens they serve. If caseworkers can't access a big-picture view of their clients, they don't have the best information for allocating available resources. As a consequence, instead of quickly deploying overlapping services in a well-coordinated fashion, agencies are unable to quickly get people back on their feet. Too often, aid recipients see outreach efforts that are piecemeal at best, or they simply fail to understand--and therefore benefit from--the very programs designed to help them become self-sufficient. Purely from a cost perspective, the longer it takes a family to return to self-sufficiency, the more services they consume. From a family's perspective, the lack of coordination is frustrating--at the very least--and often requires full-time "bureaucracy navigation," rather than focusing their energies and attention on the more immediate concern of pulling themselves up by their bootstraps. Finally, the more layers of bureaucracy, the more time and money states spend managing that bureaucracy, rather than delivering services.

A Plan for Integrated Service Delivery

How do you deliver the most effective services in the most efficient ways to the people who need them most? And how do you ensure that families receiving multiple services can quickly get back on their feet and into situations where they no longer require assistance?

Accenture has created a framework to enable organizations to help improve the planning and delivery of human services by answering those kinds of questions. The framework is based on more than 20 years of experience in human service projects and on the successful implementation of hundreds of human service applications--including numerous eligibility-related systems--for government agencies.

Using the framework to understand how services relate to each other and to the public that will use them, agencies can improve service planning and delivery, revise existing processes and remedy technology disconnects, to provide everyone from caseworkers to charities with a more holistic view of each client and the range of human services programs for which they qualify. Building a detailed big-picture view also enables agencies to offer more targeted and effective assistance, to create an integrated case management system, and quickly move people onto the human service "on-ramp" to help reduce the average stay in temporary assistance programs. Finally, better coordination can overcome the complexity that hinders the delivery of different services, enabling caseworkers and charities to help people take advantage of the right assistance programs, at the right time.

Coordination enables agencies to deliver services in a family-centric fashion. Here's how: Say that after 20 years of hard work, both John and Mary Smith have been laid off from their jobs and lost their home to foreclosure. Furthermore, they have a child with special needs--the child could be disabled, have learning problems, or suffer from mental health issues--and lost their health care along with the jobs. Now, the family qualifies for unemployment assistance, job training assistance, immediate cash assistance through the Temporary Assistance for Needy Families (TANF) program, food through SNAP, and children's health coverage. Typically, however, the Smiths would have to cobble together available services on their path to again becoming self-sufficient. But with integrated services delivery, the Smiths could understand and apply for all benefits very simply--via a single portal. Their housing coordinator could easily see what the child's health worker is doing, understand job retraining plans, coordinate with other agencies, and so on. As a result, the family could more quickly receive all of the benefits they need and rapidly return to self-sufficiency.

Simpler is Better

It's worth looking more closely at simplification as a benefit of coordinating services--as well as a hallmark of success. For example, here's what ACCESS NYC users see: An online portal providing anytime access to essential information, including office locations and required documentation, an anonymous pre-screening process, and a streamlined application process that enables people to print blank or partially pre-filled applications. Furthermore, it works in seven different languages: Spanish, Chinese, Korean, Russian, Arabic, Haitian-Creole, and English.

Here's what users don't see: Everything behind the scenes, including the multitude of policies, technologies and legal or legislative requirements associated with the 15 different city, state and federal agencies behind those 35 different programs. For some programs, for example, eligibility ensures enrollment, while for others, it doesn't.

As a result, everyone benefits, including the city and its caseworkers. For a start, that's because ACCESS NYC generates easy-to-read application forms for caseworkers. Furthermore, administrators can begin adding additional services to the portal, such as tying it into the city's centralized 311 call center.

Framework Coordinates Four Services

What's needed to improve and ultimately simplify service delivery today is an approach that realigns service delivery so that it is cross-program and family-centric--that is, addressing the complex situation that a family receiving benefits, such as the Smiths, is in, rather than simply providing one disconnected service at a time.

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To accomplish this, the Accenture framework begins by grouping human services into one or more of the following categories:

* Prevention Services help prevent or limit the need for government services in the future. Examples include childhood immunization programs, to prevent devastating and costly future illnesses, and public education, which helps prevent unemployment by ensuring that employers have access to a skilled workforce.

* Intervention Services--aka the "social safety net"--share a common objective: to assist a family during a crisis, for a limited period of time, before returning them to self-sufficiency (or hopefully, better) as quickly as possible. Examples include unemployment assistance and job retraining (for laid-off workers), and housing-, nutrition-, or income-assistance benefits (to help low-income families regain self-sufficiency).

* Protection Services protect individuals from a real or perceived threat, perhaps for the rest of their lives. Examples include child protection services, adult abuse and neglect services, and domestic violence shelters.

* Support Services aid recipients for the rest of their lives, because their circumstances warrant it (for reasons of mental health or long-term disability), or because they have earned such support (for example, pension, veteran, or Social Security benefits). In either case, support is designed to deliver not just financial benefits, but also a good quality of life.

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