A Family Perspective on Services Integration

The United States has a complex public and private system of services designed to assist families and individuals meet their needs. These services are provided by a wide range of organizations including government agencies, Private nonprofit organizations, schools, employers, community-based organizations, religious organizations, and informal networks of friends and relatives. Many of these organizations provide specifically defined services to those who document a need. However, this service delivery system is not designed to deal effectively with families and individuals who are experiencing multiple, interrelated difficulties. In this situation, a focused program may alleviate one specific problem but be unable to assess and treat the broader syndrome of problems affecting a given family or individual. Some problems presented to a given agency may be symptoms of other problems; for example, a child having trouble in school may be living in a family beset with violence, substance abuse, or other problems. These problems are beyond the reach of a tutoring program that attempts to improve a student's academic performance. In addition, families with multiple, severe problems are unlikely to have the skills and resources necessary to identify and access the multiple services needed to address their complex problems. Families with multiple problems need comprehensive, coordinated, and intensive assistance that is not available in a service delivery system made up of autonomous, narrowly defined programs. They need integrated and sustained interventions delivered by professionals who recognize and are able to respond to a family's multiple problems and needs National Commission on Children, 1991). This article uses an ecological systems model and a family perspective framework to provide a rationale for policies that guide the development of integrated delivery systems or families and individuals with multiple problems. The ecological systems model of human development articulated by Bronfenbrenner (1986) focuses on four ecological levels, each nested within the next according to its immediacy to the developing person. The most immediate level, the microsystem, consists of a network of face-to-face relationships experienced by an individual including family, peer, and school-based relationships. The mesosystem is the interlinked system of microsystems in which an individual participates, such as linkages between the family and the school. The external environments in which a person does not participate but which exert indirect influences, such as the work settings of family members, are referred to as exosystems. Finally, the macrosystem consists of the broad belief systems and institutional patterns that provide the context for human development. This model provides a framework for looking at ways in which intrafamilial processes ate influenced by extrafamilial conditions and environments. This approach is useful in the analysis of human services delivery policy because it draws attention to the multiple levels of influence on individuals and families. Applying this model to individual and family problems requiring assistance from human services suggests the importance of a family perspective in the development of human services policy. A family perspective involves viewing individuals in the context of their family relationships and using the quality of family relationships as a criterion to assess the impact of policies and programs (Lynch & Preister, 1988). A family perspective provides a framework for policy that addresses the ecological context in which family-related problems occur. This family perspective also suggests guidelines and goals for the development of integrated services policies, which, in turn, provide criteria for reviewing the effectiveness of a variety of such programs. Their familiarity with the ecological systems model and a family perspective indicates an important role for family life professionals in the development and implementation of integrated services policies and programs. …