" .
.. ' 
c',., , ; 
Department of Health and Human Services

OFFICE OF

INSPECTOR GENERAL

SERVICES INTEGRATION

FOR FAMILIES AND CHILDREN

IN CRISIS

f,RVICES' 
Richard P. Kusserow 
INSPECTOR GENERAL 
'0 
JANUARY 1991 
Ii\rdm  . ...-.-- . 
.. c  i . 
OFFICE OF INSPECTOR GENERAL

The mission of the Offce of Inspector General (OIG), as mandated by Public Law 95-452, as 
amended, is to protect the integrty of the Deparment of Health and Human Services ' (HHS) 
programs as well as the health and welfare of beneficiares served by those programs. This 
statutory mission is cared out through a nationwide network of audits, investigations, and 
inspections conducted by three OIG operating components: the Office of Audit Services, the 
Offce of Investigations, and the Office of Evaluation and Inspections. The OIG also informs the 
progr 
Secretar of HHS of  and management problems and recommends courses to correct 
them. 
OFFICE OF AUDIT SERVICES 
The OIG' s Offce of Audit Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examne the performance of HHS programs and/or its grantees and contractors in 
caring out their respective responsibilties and ar intended to provide independent 
assessments of HHS program and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and effciency throughout the Deparment. 
OFFICE OF INVESTIGATIONS 
The OIG' s Office of Investigations (01) conducts crimial, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiares and of 
unjust enrchment by providers. The investigative efforts of 01 lead to criminal convictions, 
administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 
control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 
OFFICE OF EVALUATION AND INSPECTIONS 
The OIG's Offce of Evaluation and Inspections (OEI) conducts short-term management and 
progr 
evaluations (called inspections) that focus on issues of concern to the Deparment, the 
Congress, and the public. The fmdings and recommendations contained in the inspections 
reports generate rapid, accurate, and up-to-date information on the effciency, vulnerability, and 
effectiveness of deparmental programs. This report was prepared in San Francisco under the 
direction of Regional Inspector General Kaye D. Kidwell and Deputy Regional Inspector 
General Paul A. Gottlober. Project staff included: 
Ellen Koder Project Leader  Don Loeb 
Brad Rolln Lead Analyst  Jennifer Mallen 
Elizabeth Bell  Bnan Pattison 
Robert Gibbons  Tom Purvis 
Cynthia Lemesh  Ruth Folchman  Headquarters 
Dysfunctional Families in the Head Star Program: Meeting the Challenge 
Related Reports: 

(OAI-09-89-01000); " State Programs to Provide Shelter and Temporary Housing for Families 
((OAI-07-89-01300); "State and Loal Perspectives on the McKinney Act" (OEI-05-90-01090); 
Homelessness Prevention" (OEI-07-90-00100); and "HIV and Street Youth" 
(OEI-Ol-90-00500).  -''' ' ".;'.., 
, t. 
-"- IL(
 
Department of Health and Human Services

OFFICE OF

INSPECTOR GENERAL

SERVICES INTEGRATION

FOR FAMILIES AND CHILDREN

IN CRISIS

~ Sf,RVICES' 
Richard P. Kusserow 
INSPECTOR GENERAL 
OEI-09-90-00890

Ii\rdm
 -; .. 
., - 
1; "
1("-
EXECUTIVE  SUMMARY

PURPOSE 
The purpose of this inspection was to identify a varety of innovative and/or effective initiatives 
that public and private agencies have underten to integrate services at the community level for 
dysfunctional or multiproblem children and famlies, paricularly in inner cities. 
BACKGROUND 
As par of his initiative to strengthen the American family, Secreta Sullvan has identified 
increased access of youth and their famlies living in poverty to a wide 
aray of developmental 
and support services and income assistance as a key objective. In response to this interest, the 
Assistat Secretar for Human Development Services requested that the Office of Inspector 
General (OIG) identify and describe organizations that provide integrated services for 
dysfunctional or multiproblem children and famlies. 
Services integration refers to efforts to establish linkages that contrbute to the effectiveness, 
efficiency, and economy of human services programs. A wide range of public and private 
agencies have underten services integration initiatives in an attempt to meet the growing 
challenges presented by dysfunctional children and famies. Based on case studies of 13 such 
initiatives, this report describes (1) the varety of approaches used to integrate services, (2) the 
potential benefits and limtations of services integration, and (3) the major barers to services 
integration and how such barers may be overcome. 
This is one of two reports prepared by the OIG. This report focuses on initiatives underten at 
the community level. A companion report, entitled "Services Integration: A Twenty Year 
Retrospective" (OEI-01-91-00520), describes initiatives that the Federa government, especialy 
Deparment of Health and Human Services, has undertaken to promote integrated services 
during the past two decades. 
METHODOLOGY 
This inspection used a case study approach involving on-site fieldwork at 13 agencies located in 
9 States and the Distrct of Columbia. We identifed potential case studies by sureying the 
relevant literature and conducting telephone interviews with more than 70 leading experts from 
government, academia, and private organizations. We purosefully selected our final sample 
based on (1) the initiatives' reputations for innovativeness and effectiveness, (2) the diversity of 
their integration approaches, (3) geographic balance, and (4) balance between public and private 
agencies. Our on-site fieldwork included a review of avaiable background information 
interviews with agency officials, and observations of program operations.  ..t,  -f,
FINDINGS 
Organizations that integrate services are diverse 
The organizations differ in their (1) administration, (2) impetus for integrating services, (3) size, 
(4) funding sources, (5) target populations, (6) service locations, and (7) staffing. 
Organizations use a variety of integration approaches 
All of the agencies use a combination of at least thre different integration approaches. The most 
frequently used approaches are case management, interagency agreements, and collocation. 
Others include coapplication or coeligibilty procedures, noncategorical funding, and program 
and/or agency consolidation. 
All agencies encountered barriers to services integration 
The major barers have been (1) the bureaucratic nature of the human services system 
(2) professional and philosophical differences, and (3) inadequate resources. 
Barriers to integrating services were reduced and, in some cases, overcome 
Methods used to reduce or overcome barers include (1) staff persistence and dedication 
(2) discretionar funding, (3) effective relationships with other agencies, and (4) strong political 
leadership and central coordination of public agencies. 
Despite the diversity of the agencies, substance abuse, housing, and lack of parenting skills
are common client problems 
This finding reiterates a conclusion of a November 1989 OIG report, "Dysfunctional Families in 
the Head Sta Program: Me~ting the Challenge" (OAI-09-90-01000), in which we found that 
the problems most frequently faced by dysfunctional famies involve substance abuse, lack of 
parenting skills, child abuse, domestic violence, and inadequate housing. 
Clients benefit from integrated services 
All agencies believe that integrating services has had major benefits for clients and been a major 
factor in their programs ' success. Integration makes services more accessible, convenient, and 
complete. 
Proponents believe that the benefits of integrating services outweigh additional costs 
At least initially, all but one of the agencies required additional resources to integrate services. 
All agencies believe that the costs of providing comprehensive, integrated services to children 
and families are justified because they prevent far more costly social problems, such as 
delinquency, teen parenting, and substance abuse.  Jry 
Success depends upon client focus 
The organizations' goals for clients are ambitious and long-term, and they treat clients 
holistically. 
Success depends upon interagency cooperation 
None of the agencies has the resources necessar to meet all of its clients' needs. For this 
reason, collaboration, cooperation, and support from other organizations are important to their 
private cooperation is an especially effective means for integrating services. 
success. Public-  . . . . ..  ...   ...   ....    ....    ....    ....    ....    ....    ....    ....    ....    ....    .....    . ...   . ....     .....     .....     .....     ........ .   . . 

 .. . . . . . . . . . . . .,  ' . . . . . . . . ...   ..  ...   ...  ...    ....   ..... .      ........        .......       ........        .......      . ........         ...".....        ........         .........        ....... .        ..........          ...........           ............            ...........      .     ............             .............            ............             .............            .............             .............             .............             .............             .............             .............             .............             .............             .............             .............             ............            ...........           ...........           ...........           ...........           ..........          ..........          ........        .......       .......       .......       '......      .....     .....     .....     .....     .....     ....    ..  ..  ..  . . . . 
TABLE  OF CONTENTS

EXECUTIVE SUMMARY 
INTRODUCTION. . . 
FINDINGS 
Organizations that integrate services are diverse  . 4 
Organizations use a varety of integration approaches  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 
All agencies encountered barers to services integration  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 
Barers to integrating services were reduced and, in some 
cases , overcome
Despite the diversity of the agencies, substance abuse, housing, 
and lack of parenting skils ar common client problems. . . . . . . . 
Clients benefit from integrated services 
Proponents believe that the benefits of integrating services 
outweigh additional costs 
Success depends upon client focus. . .  . . . . . . . . 15 
Success depends upon interagency cooperation. 

APPENDICES 
Appendix A: Descriptions of the 13 organizations 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . A-
Avance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
Center for Successful Child Development
-
 A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ConServe  . . . . . . . . . . . . . . . . . . . . . . . A

Families First. . . . . . . . .  . . . . . . . . . . . . A-
Hospitality House  . . . . . . . . . . . . . . . . A-
Iowa Decategorization ............................................... A-

Lafayette Cours Famly Development Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-
Liberty Family Resource Center. . . . . 
-
 A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Little Sisters of the Assumption  . . . . . A-

New Jersey School-Based Program  . . A-
Project Giant Step  . . . . . . . . . . . . . . . A 
Youth Advocates  . . . . . . . . . . . . A-
YouthCare 
........................................................ A-

Appendix B: Unique service delivery practices

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
 . '
INTRODUCTION

PURPOSE 
The purose of this inspection was to identify a varety of innovative and/or effective initiatives that 
public and private agencies have underten to integrte services at the community level for 
dysfunctional or multiproblem childrn and famies, parcularly in iner cities. 
BACKGROUND 
As par of his initiative to strengthen the American famly, Secreta Sullvan has identified 
increased access of youth and their familes living in poverty to a wide aray of developmental 
and support services and income assistance as a key objective. In response to this interest, the 
Assistat Secretar for Human Development Services requested that the Office of Inspector 
General (OIG) identify and describe organizations that provide integrated services for 
dysfunctional or multiproblem children and famlies. 
The general.concept and rationale of services integration was stated well by former Secretay of 
Health, Education and Welfare Ellot Richardson in July 1971: 
Services integration refers primarily to ways of organizing the delivery of services 
people at the local level. Services integration is not a new program to be superimposed 
over existing programs; rather, it is a process aimed at developing an integrated 
framework within which ongoing programs can be rationalized and enriched to do a 
better job of making services available within existing commitments and resources. Its 
objectives must include such things as: (a) the coordinated delivery of services for the 
greatest benefit to people; (b) a holistic approach to the individual and the family unit; 
the provision of a comprehensive range of services locally; and (d) the rational 
( c) 
allocation of resources at the local level so as to be responsive to local needs. 
Recent years have witnessed a renewed interest in services integration. At the State and local 
levels, a wide range of public and private agencies have undertaken services integration 
initiatives in an attempt to meet the growing challenges presented by dysfunctional or 
multiproblem chijdren and famlies. Based on case studies of 13 such initiatives, this inspection 
report describes: 
the varety of approaches used to 
integrate services, 
the potential benefits and limitations of services integration, and

the major barers to services integration and how such barers may be overcome.

A companion report, en tided "Services Integration: A Twenty Year Retrospective 
(OEI-01-91-00520), describes broader initiatives that the Federal government, especially the  , ' , .
Deparent of Health and Human Services, has taken to integrate services during the past two 
decades. 
METHODOLOGY 
This inspection used a case study approach involving on-site fieldwork at 13 organizations in 
9 States and the Distrct of Columbia. We used a three-step process to select case studies. We 
first identified potential case studies by surveying the relevant literature and conducting 
telephone interviews with more than 70 leading experts from government, academia, and private 
organizations, including research foundations and public interest groups. Using standardized 
interview guides, we asked the experts to recommend State or local initiatives that innovatively 
and effectively had integrated services for dysfunctional children and families. We obtained 
further information about each initiative through telephone interviews with officials from all the 
recommended agencies that met our selection criteria. Finally, we purposefully selected our final 
sample of 13 cases. The major crit ria we used in selecting our final sample were: 
Potential of the initiatives-We  attempted to select initiatives that appeared to be the 
most innovative, effective, and replicable. 
Diversity of approaches- there are many diverse ways to integrate services 
Because 
we purosefully selected initiatives that represented a varety of different approaches. 
Geographic balance- we attempted to include initiatives from all major 
While 
regions of the countr, we gave parcular preference to those that serve major 
inner-city areas because of their large concentrations of dysfunctional or 
multiproblem children and families. 
Public and private- deliberately sought a mix of public and private initiatives. 
We 
For each initiative selected, we analyzed available background information, including 
evaluations, and conducted on-site fieldwork. Our on-site fieldwork included interviews with at 
least one high-level admnistrator and several counselors or caseworkers. We also observed 
program operations at each site. This inspection report is based on this work. 
We do not claim that these initiatives are the 13 most innovative and effective initiatives in the 
countr. The universe of such initiatives is unknown. Moreover, there is no way objectively to 
rank the initiatives that are known. We did not independently verify or assess outcomes of the 
programs.  , ' 
': 1

Figure 1 below gives basic descriptive information about these organizations. See appendix A 
for narative descriptions of the organizations.

DESCRIPTIONS OF SELECTED SITES 
FIGURE  1: 
PROG  LOCTION  ADMrS'  PRIY  MAOR  SINCE 
SERVICES 
AVANCE  SAN ANONIO  PR A'r  FAM W/ CH 0 TO 3  1973

CE 
CH DFEORV SPUCMCEES FU  CHCAGO  PRIVATE  PUAMV G IN WHI OCUHSIG 0 P TROO SJ E  C, D, E. M, R  1987

FAM 
CONSERVE  PRATE  HOMBS  . R, RS  1986 
FAM  FAM 
FIST  MICHGA  STA'r  AT RISK  1988 
HOSPITAL HOUSE  SAN FRCISCO  PRATE  RUNAWAY youm  C,  R. S  1967 
IOWA DECA TERI TlON  IOWA  STATECOUN  CH WEAR CUENS  , F, H  1988 
DLEAVAOYPEM CEO URTS FAMY  BALTIORE  RHOEUIDSINEGN P ORFO SJIENG LE  C, D. M. R  1987
RUEBOERUTRYC EF AMY  BCAOLUTINO RE  COUN  BRAELETINORSE  COUN  1989
LI 
SISTE  HA 
OF TH ASSUMON  EAST  PRVA'r  EAT  REIDEN  , D, E.  , R  1958
NE JEEY

SCHOOL-BASED PROG  NE JEEY  STA'r  TEAGERS  C,  M. R  1988 
PROJECl Gl ST  NYC  FAM W/ CH AGE  1986 
YOUT ADVOCTE  SAN FRCISCO  PRATE  RUNAWAY YOUl  E.M.R,S  1969 
YOUTCA  SEA'I  PRIA'r  RUNAWAY YOUT  E.M.R,S  1974 
R-RE 
E-EDUCATlONALKE Y STTO ESERRRVIVCEIS
GCE   SERVICES 
C-COUSELING  M-MEICAL  RS-RENT SUBSIDY 
D-DAYCA  F-FOST CA  J-JOB  MACE  S-SHETE 
H-HA/CONCR SERVICE (ICLUDES HOUSEKING. HOME  BABYSITTG)  , .
FINDINGS

ORGANIZATIONS THAT INTEGRATE SERVICES ARE DIVERSE 
The organizations we studied var in terms of their: 
administration

impetus for integrating services,

budget and funding,

agency size,

target populations and eligibility criteria,

service locations, and 
staffing. 
Of the 13 organizations, 7 are private social service agencies and 6 are public 
Administration. 
agencies. Of the six public agencies, three are admnistered chiefly by States, two by cities, and 
one by a county. However, the nature of integration itself frequendy involves the mixing of 
public and private services. Over half of the public programs we visited rely upon private, 
nonprofit agencies to deliver services. On the other hand, private agencies, such as ConServe 
depend upon public agencies to provide needed services. 
For six of the seven private agencies, services integration was 
Impetus for integrating services. 

an evolutionar response at the community level to clients ' unmet or changing needs. Youth 
Advocates, for example, began as a runaway shelter and later expanded its services in response 
to the spiraling number of youth on the streets and the increasingly complex and challenging 
problems facing these youth. In several cases, integration at the community level was fostered 
by Federal, State, or local grants which encouraged or mandated integration. 
For five of the six public agencies, the stimulus for integration was the vision and leadership of 
key individuals. Upon entering office, the Baltimore County Executive brought a blueprint for 
the reorganization of county social services. Firmly committed to integrating services, his efforts 
have resulted in the initial development of a countywide network of multiservice centers. 
The size and source of agency budgets further ilustrate the diversity of 
Budget andfunding. 

the organizations. While ConServe s annual budget is approximately $223,000, Project Giant 
Step s 1990-91 budget wil be $30 milion. Funding is provided by Federal, State, and local 
governments, as well as private sources, such as foundations. All but one of the agencies derive 
funding from a combination of sources (see Figure 2), but the proportions var. While ConServe 
currently receives virtually all of its funding from private sources, Project Giant Step is nearly 
100 percent publicly funded.  . .
FIGURE 2 
Funding Sources are Diverse 
FEDERAL  STATE  LOCAL  PRIVATE 
AVANCE 
CENTER FOR SUCCESSFUL CHILD 
DEVELOPMENT 
CONSERVE 
FAMILIES FIRST 
HOSPITALITY HOUSE 
IOWA DECATEGORIZATION OF 
CHILD WELFARE SERVICES 
LAYFAYETTE COURTS FAMILY 
DEVELOPMENT CENTER 
LIBERTY FAMILY RESOURCE 
CENTER 
LITTLE SISTERS OF THE 
ASSUMPTION 
NEW JERSEY SCHOOL-BASED

PROGRAM

PROJECT GIANT STEP 
YOUTH ADVOCATES 
current and/or former funding sources. 
Specifically mentioned  as 
In many cases, organizations have a diverse funding base because no single source would allow 
them to provide the range of services required to meet client needs. For example, Little Sisters 
of the Assumption relies upon city grants for its "Grandmother" program, State and Federal 
funds for food and nutrtional assistace, and Medicaid reimbursement for home health services. 
The size of the agencies vares in terms of (1) the number of clients served, (2) the 
Agency sizes. 

number of sites offering services, and (3) staf size. New Jersey s statewide School-Based 
Program employs more than 200 staff who serve approximately 10,000 clients at 29 schools 
throughout the State. In contrast, ConServe s five staff work in a four-room office which serves 
as a hub for their home-based services. During the most recent 2-year period, ConServe served 
251 familes.

Target populations  Alll3 agencies target specific populations. For 
and eligibility criteria. 
example, YouthCare tagets homeless and runaway youth, ConServe assists only homeless 
families who have been referred by city officials or shelters, and Avance serves low-income 
families with children under age 3.  , , 
Several organizations also target by geographic area. For example, both Lafayette Courts Family 
Development Center and the Center for Successful Child Development serve only families 
residing in specific housing projects. 
Eleven of the agencies utilize either formal or informal eligibilty criteria to limit access to the 
target population. 
Organizations provide services in a varety of settings. In many cases, these 
Service locations. 

locations were selected to increase access and convenience for clients. Service settings include 
(1) clients ' homes, (2) housing shelters, (3) neighborhood schools, (4) centers located in housing 
projects, and (5) community multiservice centers. Figure 3 ilustrates that many organizations 
provide services at more than one location. For example, Litte Sisters of the Assumption offers 
an aray of services at its main center and provides additional services in clients ' homes. 
FIGURE 3 
Services are Provided in a Variety of Settngs 
tJ 	 000000 0

ODD 
DO 
HOME OR SHELTER BASED	 COMMUNITY CENTERS  HOUSING PROJECTS  SCHOOLS 
(not including those located 
in housing projects) 
Total is greater than  13  because some programs provide services in more than one setting. 
Stafing vares tremendously among the agencies. For example, ConServe exclusively 
Staffng. 
relies upon a traditional social work staff, while other agencies have multidisciplinary teams. 
New Jersey s School-Based Program includes youth counselors, health educators, psychologists, 
child development specialists, public health nurses, family planning experts, and employment 
counselors.  . "
Several agencies are notable for their use of peers and paraprofessionals. Eighty percent of 
A vance s staff are themselves graduates of the program and serve as role models for clients. 
Youth Advocates trains teenagers to be AIDS health educators. 
ORGANIZATIONS USE A VARIETY OF INTEGRATION APPROACHES 
Agencies use a varety of integration techniques. The most commonly used approaches are 
case management

interagency agreements,

collocation,

coapplication/coeligibilty procedures,

noncategorical funding, and

program and agency consolidation.

All organizations use a combination of at least three of the above integration approaches. At the 
extreme, Project Giant Step uses five of the above approaches. 
Case management generaly refers to the assignment of clients to staff 
Case management. 

whose primar responsibilties are to (1) assess the clients ' needs, (2) develop an overal case 
plan, (3) link the clients to needed services and entitlements, and (4) regularly monitor the 
clients ' progress. All agencies said that they use case management for at least some of their 
programs, but their approaches var. Famlies First case managers conduct intensive, in-home 
case management, while Liberty Family Resource Center counselors screen clients and provide 
referrals in the Center. A different approach is to convene teams of professionals to assess 
individual clients. Youth Care s "Seattle Team for Youth" involves the collaboration of several 
local agencies-including the public schools, police deparent, and the Deparment of Youth 
Services-to provide case management for at-risk youth. Agencies also provide case 
management for varing lengths of time. Some agencies provide continuing case management 
and follow-up for 5 years or more, while others conduct intensive case management for as little 
as 4 to 6 weeks. 
Interagency agreements are both formal and informal. They include 
Interagency agreements. 

agreements to make or accept referrals, share client or program information, or jointly administer 
programs. Almost all of the organizations use interagency agreements, and many emphasized 
the importance of such agreements to integrating services. 
Informal agreements are common and often are based on relationships among staf from 
different agencies. At most agencies, networking is a regular par of the staff's work day. For 
example, Hospitality House and Youth Advocates both belong to the Homeless Youth Network 
in San Francisco. Members of the network makes frequent referrals to one another and also 
meet regularly to discuss specific clients and coordinate services.  , '
Agreements to outstation staff are also common. For example, most staff at the Liberty Family 
Resource Center are outstationed workers from other county agencies. Youth Advocates has 
outstationed staff from San Francisco s Probation, Public Health, Education, and Social Services 
Departments. 
Collocation refers to the location of multiple services and/or service providers at 
Collocation. 
one facility. Nine of the agencies we visited offer multiple services at one location. Approaches 
to collocation var, however. Many agencies provide a wide range of services on site, while 
others offer only a few. The Libert Famly Resource Center houses a broad continuum of 
services, including mental health counseling, medical services, emergency assistance, housing 
assistance, public assistance, job training and employment services, substance abuse support 
groups, education and treatment, and case management. Avance, in contrast, offers fewer but 
more specialized services, such as high school equivalency education, classes in parenting and 
English as a Second Language, and child care. An agency s desire and ability to provide 
collocated services often depends upon whether the services are available elsewhere in the 
community and whether space and other resources are available within the agency. 
Four agencies use a single form or procedure to 
Coapplicationlcoeligibility procedures. 

determine eligibilty for two or more separate programs in order to simplify the application 
process, lessen the paperwork burden, and provide a broader range of services for clients. 
Noncategorical or decategorized funding allows the service provider 
Noncategoricalfunding. 
broader discretion in the use of funds than categorical fundig, which narowly restrcts the use 
of funds to specific services or beneficiares. Iowa s major integration approach is decategorized 
funding. 
This entails the consolidation of two or more formerly 
Program and agency consolidation. 

separate programs or agencies. Three agencies have integrated services by consolidating 
existing programs or agencies. 
ALL AGENCIES ENCOUNTERED BARRIERS TO SERVICES INTEGRATION 
The most important barers have been: 
the human services system

professional and philosophical differences, and

inadequate resources.

Every agency cited problems related to the bureaucratic nature of the human services system as a 
major barer to services integration. Problems include bureaucratic inerta, lack of cooperation 
inordinate red tape and delay, and complex and conflicting rules and regulations. For example 
directors and staff mentioned:  , .  , "  " "
The schools are often inflexible, even though we have good relations with the 
principal here. they have rigid closing hours and are caught up in administrative 
trivia. . 
There are long delays in the State s processing of emergency needs requests. Public 
assistance workers can be "impatient,  noncooperative " and "nasty. 
The development of flexible new services under decategorization "is moving too 
slowly because of the mindset of social workers, county directors and providers, and 
the State Department of Human Services-they re so used to thinking in terms of 
programs and accountability. 
Categorical funding barers and turf battles each were mentioned as problems by about half of 
the agencies. 
Eleven agencies identified professional or philosophical diferences as a barer to integrating 
services. The professional and philosophical differences are both internal and external. "There 
barers," commented one offcial. "Social workers like to operate in a certain way; 
are internal 
same for child specialists." Another offcial told us that his program initially encountered 
barers from some principals who did not accept the concept of school-based social services. 
This resulted in the program being assigned inadequate space at two locations. 
Resource constraints were another commonly reported barer. Seven of the agencies stated that 
space constraints prevented them from collocating necessar services on site or serving some 
clients. One program director told us: "We don t have the space to help older siblings, leaving a 
gap in services. 
Five organizations said that a lack of staff prevented them from providing clients with complete 
services. Remarked one official: 

We need more people for extended services; there is a waiting list 
We are limited in staff 
for the GED program. With these new people, we could possibly ask more questions in 
intake, thereby discovering more problems andforming deeper relationships. 
While staff at most of the agencies expressed a desire for higher salares, officials at three 
dicult 
agencies specifically stated that low salares made it  for them to recruit and retain 
qualified staf.

With only one exception, all of the organizations mentioned overburdened or unavailable referral 
resources in their communities as a barer to meeting at least some of their clients ' needs. 
Lamented one counselor  For me, the lack of services has been painful. You see kids grow up. 
Many do not survive. It could be different.  from one agency remarked that the 
" Officials 
shortage of shelter beds in their city is so great that they had to distrbute 200 sleeping bags to 
war 
help keep homeless youth  on the streets. A Public Health Nurse from another agency said 
that access to dental care is so limited that some youth have teeth "rotting to their gums.  . '
, I

BARRIERS TO INTEGRATING SERVICES WERE REDUCED AND, IN SOME CASES, 
OVERCOME 
Approaches that have helped the agencies reduce or overcome these barers include: 
staff persistence and dedication 
discretionary funding, 
effective relationships with other agencies, and 
strong political leadership and central coordination. 
We saw repeated examples where the staff' s persistence and 
Staff persistence and dedication. 

commitment to client needs succeeded in overcoming barers to services integration. At many 
agencies, case managers or counselors view themselves as client advocates and regard their 
advocacy role as one of their most important functions. "Advocacy and case management can 
open doors," commented one official. Another official expressed a similar sentiment: 
Persistence pays off. You need to stay with it. 
The importance of persistence also was noted at the administrative level. As one State 
administrator observed, "A lot of changes did not happen because people wanted them. They 
happened because of stubborn people who are not afaid of makng others mad." Commented 
another official, "We are persistent and patient. In one school, we had a closet-like room that 
was all they gave us for a famy room. We had to be very assertve to get more space. 
Most staff displayed a deeply-rooted, personal commtment to meeting the needs of their clients. 
We observed many examples of staff going beyond the normal call of duty to serve clients. For 
example 
The operational philosophy of Families First is to do whatever is necessar to 
car 
preserve famlies. Supervisors  beepers in order to be available night and day. 
Approximately 20 percent of Little Sisters of the Assumption s operating budget 
stems from staff returning their salares to the organization. 
A Youth Advocates worker prevails upon her personal friends to provide free services 
I beg my professional frends to take my kids or find friends of theirs 
for her clients. "
who will." And although she "hates" imposing on her friends, she continues to do so 
in the interest of her clients. 
Eleven agencies maintain discretionary funds which can help them 
Discretionary funding. 

overcome some of the barers created by categorical funding restrctions. While discretionary 
funds comprise a small percentage of most organizations' budgets, they nonetheless are 
important for the agencies because they fil gaps in categorical funds. Four of the agencies also 
make some discretionar funds available to caseworkers which allow them to respond flexibly 
and rapidly to emergency situations.  , .  , .  ,- -
Almost all 13 agencies stated that developing effective working 
Effective relationships. 

relationships with other organizations has played an importnt role in helping them overcome 
barriers. Informal staff networking is regarded as one of the best ways to' develop effective 
working relationships. We were told: 
Coordination takes place social worker to social worker. The most important 
linkages resultedfrom social workers developing a working relationship and trusting 
one another. 
Our networking has helped a lot. 
I spend a lot of my time networking; it correlates directly with my success. 
More formal arangements and agreements also can be effective. One program s founding 
legislation required the counties to work closely with the State s Deparment of Human Services 
and court system to implement decategorization. Local planning and implementation also was 
characterized by broadly-inclusive, parcipatory commttees that involved almost all of the 
major public and private children s services agencies. Offcials emphasized the critical 
role that 
this approach has played in helping to overcome major barers to decategorization. The State 
Senator who cared 
the legislation said: 
The juvenile court, the Department of Humn Services, and the provider community 
looked at each other as adversaries, and each had its own agenda about what it wanted 
to get out of the new project. There was a lack of communication, no understanding of 
the roles of others. There was opposition from the Governor and the Finance 
Department too. The misunderstanding in the community was overcome by getting 
together and discussing what the goals are and how many of them had common goals. 
Together, they figured out what gaps there were in services and created a working 
understanding of how the other groups worked. It opened communication links. People 
are more wiling to confer and are also more aware of what services each has to offer. 
While it did not appear to be a significant 
Strong political leadership and central coordination. 

factor for the seven private organizations, all six public agencies noted the importance of strong 
political support and leadership in overcoming barers. At one agency, offcials emphasized the 
importance of the strong support they received from the mayor and other top city offcials. They 
also noted the importance of a "superagency" which was created by the consolidation of a 
deparent of employment and a housing authority in the mid-1980s. Remarked one official 
The superagency had the power to get things done." Officials at two other public agencies 
emphasized the importce of the strong leadership provided by specially created coordinators. 
Clearly, the success of services integration depends upon human factors-
individual leadership, 
staff dedication, and effective relationships. The loss of anyone of these could threaten the 
agencies ' success and perhaps even their existence. It should be noted, however , that many of 
the agencies that are the subject of this report have provided integrated services for several years.  , "

DESPITE THE DIVERSITY OF THE AGENCIES, SUBSTANCE ABUSE, HOUSING, 
AND LACK OF PARENTING SKILLS ARE COMMON CLIENT PROBLEMS 
Staff cited substance abuse, housing, and lack of parenting  common client problems. 
skils as 
This finding reiterates a conclusion of a November 1989 OIG report  Dysfunctional Families in 
the Head Sta Program: Meeting the Challenge" (OAI-09-90-01000), in which we found that 
the problems most frequently faced by dysfunctional familes involve substance abuse, lack of 
parenting skils, child abuse, domestic violence, and inadequate housing. 
Staff at many agencies said that substance abuse was an especially difficult challenge for both 
clients and staf because (1) it is diffcult to obtain treatment for uninsured clients, (2) available 
treatment often is located far from clients ' homes, (3) many clients are resistant to treatment, or 
(4) the staff are inexperienced in dealing with substance abuse issues. "It's difficult for people to 
ask for help with a drug problem " said one caseworker. "Once they do, it would be best if we 
had someone who could at least speak to the person. As it is now, they often have a long wait 
before they can get into a treatment program. " Another caseworker estimated that 95 percent of 
the families she has worked with had substance abuse problems. 
Staff at most of the 13 agencies said that housing was a major problem. "The problem (of 
housing) is so severe that we can t even begin to help," said one agency staffer. Staff at several 
agencies complained about red tape and waiting lists as long as 5 to 7 years for the Federal 
Section 8 housing program. Furthermore, available housing may be substandard and in 
crime-ridden neighborhoods. "There is a lot of floodng, the water pipes in the floors break, rats 
and roaches are in abundance, and there is violence all the time," said one caseworker. 
Staff at most agencies identified teen pregnancy and lack of parenting skils as major problems. 
Agency staff told us: 
These kids do not even know the parts of their bodies despite the fact that they are 
very active sexually.

The cycle of teen parenting is going to get worse because so many pregnant teens are 
trying to keep their babies, who wil themselves wind up on the streets even earlier in 
life. 
Parents are of ten from dysfunctionalfamites themselves and are repeating their 
familes' patterns. 
Some children get potato chips for breakfast.  , "

CLIENTS BENEFIT FROM INTEGRATED SERVICES 
All 13 agencies stated that integrating services has had major benefits for clients and been a 
major factor in their success. 
Services are more convenient and accessible, and clients are more willing to be helped. 
The agencies cited numerous examples of how integration has made services more convenient 
and accessible for clients. Many emphasized the importance of collocation in overcoming. 
transportation and other physical barers to services. ,  Collocation means that we have a 
one-stop shopping center" and "services located on site add effectiveness and convenience" were 
typical of the comments we heard. Collocation also allows clients to be helped more quickly. 
Integration also can help overcome bureaucratic barers to access. Many agencies emphasized 
the key role case managers play in helping clients access needed services. "For a person to 
navigate the system on his or her own is often impossible," said one counselor  but a case 
manager can help refer a client to better programs, or alert the program to a client s arva1." 
Several organizations said that collocation and interagency agreements also help clients access 
tu 
services by cutting through red tape and lessening  batdes. 
Another major benefit is that clients are more willng to use the services. Case managers 
develop rapport and trst with clients who then overcome their feelings of distrust and 
frustration towards the system. "Building trst is the most important thing" a case manager can 
do. Several offcials commented that clients are more wiling to disclose their problems because 
of the special relationships they develop with their case managers. 
Services are more complete. 
All 13 agencies emphasized the importce of integration in makng their services more 
complete. In almost all cases, this was a major objective of collocation. As one program 
director remarked, "Before collocation, no one else was meeting the need  of the youth we 
serve-there were large gaps in services for this population." Interagency agreements also play 
an important role in "extending the range of services" that agencies can make available to 
clients. They allow a case manager at a homeless youth shelter to access medical services for 
her clients at a nearby multiservice center. In several cases, interagency agreements have 
resulted in the development of new community services. 
Services are better coordinated. 
Integration improves coordination of services for both clients and programs. An official 
explained, 
If we did not have case management, coapplication, and collocation, we would be very 
identifing many of the problems that our families have. 
fragmented. We would miss 
we don t know those problems, the client  independent
wil not be helped. Ifwe had  10 
agencies working with the familes, each would not know what the other is doing.  Staff view case management as one of the most effective means for coordinating services for 
individual clients. They told us, 
Therefore a case manager 
Kids have multiple service needs with multiple providers. 
is necessary; it is the vehicle for getting services, building relationships, tracking 
services, and not losing a kid. 
Case management is the piece that ties it all together for the kids. 
Without case management, it would be (helter skelter --ids wouldn t follow 
through, and they would fall through the cracks. 
Collocation also improves coordination of services for individual clients. A public health nurse 
at a homeless youth shelter remarked, 
Being on-site facilitates a useful exchange of information. I am sometimes the first 
person to whom a youth reveals something very sensitive, like a history of child abuse 
or substance abuse. Because I work in the same facility as the counselors, I know 
and trust them and can share these things with them. They do the same with me. 
Integration also can improve program coordination. One official noted, "Because of interagency 
agreements, we are able to coordinate services to best utilize the avaiable resources and improve 
communication among the varous public and private agencies that serve homeless and runaway 
youth." In several instances, interagency agreements have eliminated duplication and overlap in 
some services and filed gaps in other areas. 
Integration may create client dependency and stigmatization. 
Only four agencies noted any possible disadvantages to integrating services. Two expressed 
concern that case management or collocation could result in client dependency. The other two 
were concerned about collocating mental health or drg rehabiltation programs with other 
services. They said the stigma associated with these services can be so great that some clients 
might be reluctat to use them if they are collocated in a school, housing project, or other 
community-based settng where the clients are known. All four organizations believe that 
overall, however, integration benefits clients. 
PROPONENTS BELIEVE THAT THE BENEFITS OF INTEGRATING SERVICES 
OUTWEIGH ADDITIONAL COSTS 
Integration requires additional resources.

At least initially, all but one of the agencies required one or more of the following resources to 
integrate services:

more staff time to plan and coordinate additional services or work with additional 
systems,  , '
more counseling staff because of case management s intensity, and 
more physical space and computers. 
While integration required more of some resources, it frequently decreased the need for other 
resources. Several agencies said integration has: 
reduced the amount of time staff must spend on tasks such as making referrals,

eliminated duplication or overlap of services,

allowed the same space to be used for multiple purposes or allowed several agencies

to share the same equipment, and

let agencies take advantage of unused free space in another organization s building.

Services integration yields long-term benefits to society. 
All 13 agencies believe that the cost of providing comprehensive, integrated services to children 
and families is justified because they prevent far more costly social problems, such as 
out-of-home placements, delinquency, teen parenting, and substace abuse. For example 
The founder of the Center for Successful Child Development estimates that it costs 
society $300,000 in welfare and other costs for each child who "fails. 
A report that resulted in the initiation of Project Giant Step concludes, "If $2 700 per 
young child seems expensive, it pales in significance when compared to as much as 
$10,000 that can be spent per child on remediation or up to $50,000 that can be spent 
on special education throughout a child' s school life. 
According to the State of Michigan, the $4 500 one-time cost of its Famlies First 
intervention program is small when compared with the $10,000 recurrg annual cost 
of foster care. 
SUCCESS DEPENDS UPON CLIENT FOCUS 
The organizations ' goals are not simply to provide services to children and families. Rather 
their goals generally are more far-reaching-to "empower" or "strengthen" clients and help them 
become self-sufficient. "  re essentially tring to work ourselves out of ajob by tring to get 
the family to help itself " said one program diector. 
In order to achieve such far-reaching goals, the agencies recognize the need to treat clients 
holistically. That is, they (1) focus on the whole famly, rather than a single famiy member 
(2) treat all the family s problems together, rather than just one or a few in isolation, and (3) see 
that clients ' long-term needs are addressed in addition to their immediate needs. 
Frequently, one member s problems affect the entire family unit, because the problems are 
linked. For example, Avance recognizes that a small child' s health and socialization problems  may result from a teen mother who lacks parnting skils. In order to prevent future problems 
with the child, Avance offers parenting classes in addition to those services the child immediately 
requITes. 
Similarly, agencies attempt to address all of a famly s needs because they may be linked. The 
agencies recognize that clients' problems are multiple and interrelated. For example, a client 
severe depression may lead to loss of employment, drug abuse, and a host of other problems. In 
many cases, treatment wil not be effective if problems are not addressed comprehensively. 
Because the agencies' goals for clients typically are.ambitious and far-reaching, their services 
address clients' short-term and long-term needs. Youth Advocates offers aftercare counseling 
services, and ConServe recendy began a new program that wil serve clients over a 5-year 
period. Other organizations meet clients' long-term needs by extending case management or 
referrng clients to agencies that provide long-term services. 
SUCC DEPENDS UPON INTERAGENCY COOPERATION 
ESS 
None of the agencies has the resources necessar to meet all of the many needs of its clients. For 
this reason, collaboration, cooperation, and/or support from other organizations is important to 
their success. The importt roles other organzations play ar many and diverse. They frequendy 
provide important financial or technical support,

play key advocacy roles,

make referrals that help the agencies reach their target populations, and

provide referral services that allow clients' needs to be met more completely.

Avance, for example, relies on approximately 70 social service agencies in its community to 
meet many of the needs of its clients that its own programs do not address. 
Cooperation among public and private organizations is often important in integrating services. 
Public and private agencies each have paricular strengths, and integration may be especially 
effective when the strengths of both are combined. Prvate agencies often are able to respond 
flexibly and rapidly to client needs, while public agencies often have the financial resources or 
authority to mandate that clients or other agencies parcipate in programs. Liberty Family 
Resources Center and Youth Advocates ilustrate the benefits that can result from public-private 
cooperation. 
The private agency at the Liberty Family Resources Center fils gaps in public 
services, for example, by distrbuting emergency food and clothing and providing 
rapid crisis assistance when utilty shutoffs and evictions are threatened. 
Youth Advocates' effective working relationship with the city police department and 
the outstationing of a city probation officer have allowed youths who otherwise might 
have been placed in juvenile detention to be served immediately in a more stable and 
nurturing home-
like setting.  ".- -----.--.'---..-
APPENDIX A

DESCRIPIONS OF THE 13 ORGANIZATIONS

AVANCE

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
AVANCE  SAN ANTONIO  PRIVATE  FAMILIES W/CHILD 0 TO 3  1973 
MAOR SERVICES: COUNSELING , DAYCARE , EDUCATION , REFERRALS 
The buildig, with its colorful pastel murals of Peanuts characters and Avance s name 
prominently displayed, stands out from the gray buildings in the housing project. The space is 
war 
limited, but it creates a  atmosphere instead of a crowded feeling. Avance vans pull up 
surundig 
briging mothers to classes from their homes in the housing project and the  community. 
All Avance centers are centrly located in low-income neighborhoods, three in San Antonio and 
one in Houston. A vance has been a par of the Texas Hispanic community for 17 years. It 
provides one center in each area where famlies with a child age three and under can receive 
integrated support. Avance shows parnts that this early developmental period is critical and 
reminds them that they are their children s fIrst teachers. Parents ' love for their children and 
desire for their success provide the initial foundation for Avance s work. 
Three smal rooms, side by side, constitute the child car center in San Antonio s Miasol 
housing project. An overfow of cribs in the reception room marks the need for more space. 
Children play in the fIrst-floor child care center while 12 mothers sit around a table upstairs 
sewing puppets as par of the toy-makng class. This activity provides the mothers a chance to 
build relationships with other women in the community and to share experiences about how their 
children lear through play. For 9 months, these women wil lear and work together to become 
better parents. Many of these women are unmared, high school dropouts, and lack job skils. 
They contend daily with physical abuse, severe depression, economic despai, and isolation. It 
looks as if a youngster has joined these mothers to share in the fun, but it turns out that this 
12-year-01d is a mother herself. 
In the nex;t room, the parenting skills teacher leads another group of women in a discussion about 
the need to treat children faily and with respect. Though these lessons, the teachers emphasize 
tang 
the importance of each mother  to her children. Many of these children lag behind in 
language skills. When they reach school age, these children not only cannot speak English, but 
are deficient in Spanish as well. 
Later, the class wil paricipate in peer review by analyzing videotapes of each mother 
pinteracation writh heer chnild. Avtancie stnaff magke two. m onthly visits to each families ' home where 
they videotape mothers playing and talking to their children. Back in class, mothers get a chance 
to review and critique each parent s interaction and lear though example what constitutes good '...-, . "'- --'." _.""
7----'.' 
The last room has become a make-shift medical examning room. Cries of infants and toddlers 
are heard as senior nursing students from nearby medical schools administer physical and 
developmental exams. 
Each week, the parenting classes teach mothers how to access the social services available in the 
community. For these outside services, Avance provides door-to-door transporttion, child care 
and assistance with paper work. Sometimes staf even represent the client. Avance uses case 
management to serve familes with special needs; the parenting teacher, center manager, and 
child specialist meet weekly to discuss these clients. 
There is a more formal and professional atmosphere at Avance headquarers, where a smiling 
receptionist greets visitors. She is an Avance graduate who came to the program with four 
children, no job and a poor education. She found out about Avance when staff recruited families 
at the housing project, somethg they do twce a year. Mter going thugh the 9-month parnting 
progr, 
she could see and feel a difference in herself and her chidren. She wanted to go furer and 
worked hard for 2 months to complete her Genera Equivalency Diploma offered at Avance. She then 
received computer trnig thugh Avance efforts and staed a plyig for jobs. 
Propelled by her newfound hope, she soon was deflated to discover so many obstacles in the 
way of gettng a good job. She did not have appropriate clothes for job. interviews and found 
that most employers wanted someone with experience. She relayed these problems and 
frustrations to Avance staff. The diector, then hiring a secreta, decided to offer her the job on 
priarly 
to give her the job experience she desperately needed on her resume. She 
a tral basis, 
so impressed the director with her skils, she was hird permanently and is stil with Avance. 
With parenting education, there is a chance for these low income children and parents to 
priary 
discover a new value and capabilty in themselves. Avance works  with mothers to 
instil in them hope and independence to succeed. There are stil barers, including the 
inadequate involvement of fathers. Though programs like the Fatherhood Project, Avance is 
attempting to stem some of these barers. 
In some cases, Child Protective Services refers abused and neglected children to Avance. 
Avance begins with home visits for physical and developmental evaluation and one-on-one 
parenting instrction. Once past the crisis point, these famlies join classes at the Avance center. 
Avance is proud of its graduates. The center s walls ar interspersed with pictues of mothers 
and children donning caps and gowns worn at their graduation ceremonies. Eighty percent 
of the 
Avance staff are Avance grduates. These women become role models and foster self esteem 
and pride in new enrollees. 
For more information contact:  Avance 
Administrative Offce 
301 South Frio, Suite 310 
San Antonio, TX 78207 
(512) 270-4630 
Gloria G. Rodrguez, Executive Director  . " ---'--' .,-. , -..---....---...
CENTER FOR SUCCESSFUL CHILD DEVELOPMENT 
PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
CENTER FOR 
FAMILIES W/CHILD 0 TO 5
SUCCESSFUL CHILD  CHICAGO  PRIVATE  1987
IN HOUSING PROJECT
DEVELOPMENT 
MAOR SERVICES: COUNSELING , DAYCARE , EDUCATION , MEDICAL SERVICES , REFERRALS 
As we enter a global economy, the quality of the domestic work force is of critical importance to 
Ameri  an industry. Businesses are concerned. In a recent speech, the Chaian of the Ounce of 
Prevention Fund remarked that, in 1989, 37 percent of 18-year-olds were functionally iliterate. 
Yet, as he notes, this is merely the product of problems developed early in life. 
Every year, thousands of babies are born at risk of being mentaly and developmentally disabled. 
Damage occurs in the womb due to a mother s lack of knowledge about nutrtion and drug use. 
After birt, many parents do not provide the stimulation for proper childhood development. By 
the time these kids are toddlers, they are significandy impaied. These children and families 
need a range of services much earlier than those offered though traditional programs. 
The Center for Successful Child Development (CSCD), commonly known as the Beethoven 
project, serves 6 of the 28 buildings comprising the Robert Taylor Homes. It offers a stark 
contrast to the surroundig neighborhood. With its 20,000 residents, this Chicago housing 
project is the largest and one of the poorest in the nation. The povert is betrayed by the tall 
buildings and grounds. Graffiti, cracked concrete, and a general sense of despair pervade. 
Check-points, securty guards, and locked doors, all necessar, bar easy access to CSCD. Once 
inside, however, the atmosphere changes. 
The center s warth and optimism can be felt immediately upon entering the reception area. 
People scurr in and out, determned to meet the agency s mission. CSCD's main goals are 
(1) "to promote the healthy growth and development of children from before 
birh through age 
five in all domains of development (social, emotional, physical and cognitive), and to prepare 
them for achievement at entr to formal schooling," and (2) "to help parents build on their 
strengths as individuals and as parnts." The most effective means of helping a child, CSCD 
believes, is through helping the entire famly. 
CSCD attempts to work with all children born after September t, 1987, and their families living 
in the catchment area of Beethoven Elementar School. Their hope is to make an impact on the 
1992-1993 kindergaren class and beyond. 
Families are encouraged to paricipate in the program through the urgings of the parent and child 
advocates (PCAs). These dedicated individuals perform home visits and provide services and 
support to pregnant women and families. They combine the roles of case manager, outreach 
worker, and advocate. The bonds they develop with the familes are so strong that "clients never 
leave us. They wil always come and let us know how things are going.  '..-. "'- --- -"-
.- h'____-O-O

Once a famly chooses to use CSCD' s services, they are introduced to everyone working at the 
center that day, including the janitor. In the process, the family weaves through a maze that 
formerly comprised ten aparment units. The tour takes them through rooms filled with toys 
designed for nurtring play. They wal past parnts, with children at their knees, making 
construction-paper cats. They leave the center with a better understanding of the services 
provided and an introduction to the agency s philosophy. 
In contrast, years of bureaucratic "red tape" conditioned the residents of RobertTaylor Homes to 
distrst agencies. Once the famly builds a relationship with one program, it generally won 
make use of others. Paricipation hinges on centrally locating desired seryices under the 
umbrella of one program. To answer this concern, CSCD added an on-site medical clinic 
drop-in center, and day care unit to the established PCA component. 
Staf canvassed familes living in the target buildings and leared that day care was the highest 
priority request. After many trals and considerable expense, the center opened offering 14 slots 
year-01ds. To be eligible, the mother must go to school, work, or both. The day 
for infants to 2-
care is interactive and stimulating for the childrn. For the 3- and 4-year-01ds, CSCD maintains 
a working relationship with St. Paul' s Head Star center. Located nearby, this standard Head 
Star model includes a developmental preschool program, social and health services, and parental 
involvement. 
Stress comes with parenting. Period!" the Coordinator of Children s Services emphasized. To 
help defuse these stresses, the drop-in center acts as a famly support 
unit. Activities are 
centered around what the paricipants want. As these activities tae place, parents lear 
child-rearng skils though the informal role-modeling of the workers. Instead of constantly 
teaching, a worker s attitude toward the parents is that "I can lear as much from you as you can 
lear from me. 
The primar health care component provides a varety of medical services to the taget children 
and their siblings to age 12. The extreme need for including medical care is best ilustrated by 
the full waiting rooms and long lines that greeted the staf when the clinic fist opened. Today, 
the center provides physicals, some lab work, hearng and vision screening, general first aid, and 
immunizations. The nurse practitioner fmds she is often called on to answer parents ' questions 
ranging from nutrtion to child safety. For adults, the clinic conducts pregnancy screenings and 
is seeking someone to provide famly planning servces. In speakng of her role in the holis 
treatment of the childrn, the nurse practitioner said, "I think most of our goals and objectives 
are centered on producing healthy babies and children. I'm sure we re maing some impact. 
Possibly the most intrguing aspect of CSCD can be found in its funding stream. The founder of 
the agency is, at the same time, the chairman of his personal foundation. Although the agency 
makes use of available grants, this uncommon relationship has freed monies for new projects, 
new staff, and new equipment. For example, the medical clinic opened immediately without 
having to wait for grant approval. Once the Robert Wood Johnson Foundation approved a 
multi-year grant, funds from the founder s personal foundation were no longer needed. While 
most programs speak of funding concerns, the founder states, "  ve never not done anything 
due to funding shortfals. We ve never had to adjust the program (or) mission to chase funding. 
A-4  - - " --" ...-.
In the eyes of the workers at CSCD, the agency is a success. One worker summed up the 
We all believe there should be more centers like this one. 
. collective feeling, "
For more information contact:  Center For Successful Child Development 
188 West Randolf Street, Suite 2204 
Chicago, IL 60601 
(312) 855-144 
Laura Devon-Jones, Director of Media Relations  .... ""'----"' '..- .
CONSERVE

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
CONSERVE  PRIVATE  HOMELESS FAMILIES  1986 
MAOR SERVICES: COUNSELING , REFERRALS , RENT SUBSIDIES 
Cities all over the United States are grappling with the homeless problem. The issue is no longer 
just finding shelter, but providing safe, clean accommodations which facilitate rehabilitation and 
self-sufficiency. For homeless families in Washington, D.C., however, entrance into the city 
shelters can prove dangerous and dehumanizing. Not only does the family have to endure crime 
drugs, and the mentally il, but .also the loss of control over its own decisions. A 5- to 7-year 
waiting list for Section 8 housing also confounds the problem. An innovative program exists 
however, that not only provides a way out of the shelters, but also offers a substantial cost 
savings to D.C. government. 
ConServe is a private, nonprofit social service provider that was formed in the mid-1980s by a 
consortium of 10 nonprofit agencies that recognized their services to homeless families were 
being offered in a "piecemeal" fashion. That is, they faied to respond to a family s multiple 
problems or treat them holisticaly. Each agency provided one or two services. ConServe was 
created to provide case management and to faciltate and coordinate access to services for 
families in homeless shelters. 
Working under the premise that famly care and treatment are more effective when the family 
living situation is stable, ConServe implemented a program in 1987 to provide rent subsidies to 
get famiies out of homeless shelters and into permanent housing. The subsidy program is the 
core of ConServe. "Many needs disappear when people are in their own place," said the 
Executive Director. 

Not only does the rent subsidy provide a stable home environment, but at a starling cost savings. 
According to ConServe, its average monthly cost per family for both housing and social services 
is $600, which the city has paid through a contract with ConServe. In comparson, D. 
government pays temporar shelters $90 per night for a famly, or $2700 per month. 
ConServe requires that familes who wish to receive the subsidy sign a "contract" to work with a 
ConServe caseworker towards achieving self-sufficiency. In return, ConServe offers 
comprehensive, intensive, long-term case management. 
ConServe case managers go right to the hear of the problem-into the family s home-not only 
to ease the burdens of transporttion and child care, but to get a fIrst hand view of the family 
dynamics. Case managers can then offer a wide range of services through both the consortium 
agencies, other private service providers, and government programs. Caseworkers work as 
advocates for families, frequently following up with service providers.  , ' ,. 
Case managers work with a family over a period of months or years, during which time the 
family s needs change, and goals are adjusted. "GoO case management is longitudinal " said 
the Executive Director. "  s not a one-stop deal. 
ConServe has limited caseloads to 15 or 20 families per case manager in order to give each 
family the attention it requires. One case manager stated that caseload is the single most 
important factor affecting staf'  client. In addition, being a small agency is 
s abilty to help a 
advantageous because it has remained non bureaucratic and responsive to the changing needs of 
its target population. 
Mark is one example of how ConServe s unique approach benefits homeless families. Poorly 
educated and barely above the poverty level, Mark was left to care for his daughter when his 
estranged wife was convicted of a drg-related offense. City authorities theatened to place his 
daughter in foster care, but he fought the city and won. In doing so, however, he lost his job. 
Eventually Mark and his daughter landed in one of D.  s temporar shelters. Shelter officials 
acquainted with ConServe notified the agency. Mark was given a long-term housing subsidy and 
was assisted in finding an aparment and a decent job with benefits. Mark' s wilingness to seek 
help was due largely to his motivation to give his daughter a chance at a decent life. 
ConServe s effectiveness depends just as much on the quality of services to which the case 
Mark was able to benefit pary because ConServe has developed both 
managers refer famlies. 
formal and informal agreements with other private and public. service agencies. The consortum 
agencies are able to offer housing maitenance, medical, mental health, and emergency food and 
clothing. But while the relationships between the consortum agencies are formal, ConServe 
staff stressed the importce of informal linkages with all referral agencies. Most of these 
linkages occur among social workers building working relationships and trust with other service 
providers rather than among management. 
The Executive Director argues that ConServe s concept is neither difficult to implement nor 
difficult to manage. "If (the rent subsidy program) can work in D.C., it can work anywhere. 
He added that case management is not a new concept: "You don t have to reinvent the wheel." 
He also argued that case management is more necessar in areas where agencies may be far apar 
and fail to communicate effectively. Meanwhile, ConServe has sought to solidiy its own 
standing by searching for reliable long-term funding source that "would allow us to use the 
(funds) in a flexible manner." In the meantime, however ConServe is forced to deal with 
government agencies that are, "at allievels,...poorly designed to coordinate services" and that 
fail to foster an environment conducive to the integration of services. 
For more information contact:  ConServe 
1536 16th Street N. 
Washington, D.C. 20036 
(202) 232-3355 
Tony Russo, Executive Director  FAMILIES FIRST

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
FAMILIES FIRST  MICHIGAN  STATE  FAMILIES AT RISK  1988 
MAOR SERVICES: COUNSELING, HARD SERVICES, REFERRALS 
Imagine that a family has been referred to the Familes First program, a program which helps 
families in crisis. What do you expect to see? A therapy session in an offce? 
Actually, the 
Familes First therapist meets with the famly in its home, usually within 8 hours of referral from 
the child protective services or youth delinquency worker. There is no waiting list. In the 
family s home, the therapist listens to the family s problems to understad the need for help. 
These families are in crisis, a crisis which may involve substance abuse, parenting problems, an 
eviction notice, no money for food, no electrcity, iliteracy, and social isolation. The crisis may 
have resulted in a recent visit by a child protective services worker. The therapist provides 
counseling and parenting education, may help plan a chore chart, or help clean the 
house-whatever it takes. These therapists often work 5 to 20 hours in a week with the family. 
They work only with 2 famlies at a time, for 4 to 6 weeks. Each therapist has the freedom to act 
immediately to respond to a family s crisis. If there is no food in the house or if the electrcity is 
off, that gets taken care of right away. Thoughout this intervention, the family grows to trust the 
therapist. One therapist said, "We often find out things that the famly has never told to anyone. 
One Families First therapist was asked to work with a famy of five: mother, father and three 
children. When she first visited the home, the building was run down, with the porch tilting 
because of a foundation shift. Inside, there were a few mattresses, a stool, a crate, and a broken 
couch. There was no heat. The children had few toys. The parents had sold the furniture to buy. 
crack cocaine. They said they cared about their children and, somehow, always made sure the 
children had food to eat. The therapist helped the family get emergency food, clothing and 
furniture and move to another home. Over the weeks, she worked with the parents to resolve 
differences and helped them get into drug treatment. The famly and therapist also created chore 
chars and a daily schedule. After these brief weeks of intensive therapy and education, the 
Families First intervention was completed except for checking with the family at regular 
intervals. During the next year, the parents faced another drg-involved crisis; the mother and 
father both sought treatment on their own this time, but the crisis resulted in the breakup of their 
relationship. The children were never separated and still live with the mother. 
When a famly needs someone to call, the therapist is available, 24 hours a day, 7 days a week. 
The family doesn t have to wait for the offce to open in the morning. It often has the therapist 
home telephone number or the number of a beeper cared by the therapist. Famiies First 
provides immediate, comprehensive service to the famly, when and where the family needs it 
most. 
Within 4 to 6 weeks, the famly is stronger and more resourceful, and its support network of 
friends, relatives, and community agencies has been reinforced. The therapist has done his job 
and concludes the service. The therapist does not keep the famly dependent; the goal is to build 
the family s self-sufficiency. The therapist checks in with the family 3, 6, and 12 months 
afterwards, but the famly may call for support anytime.  , "

, ,' '
A family, like an individual, responds to the expectations of others. This is why Families First 
builds upon the famly s strengths. The program follows a philosophy called "family 
preservation " which contends that the childrens ' needs are often best met by strengthening and 
empowering the family rather than removing the child from the home. This approach has been 
used since 1974 in a Tacoma, Washington, program called "Homebui1ders 
Familes First was formed amid rising foster care costs and community dissatisfaction with the 
quality of service provided to these families. As one administrator put it  Everyone in power 
from the governor on down, made a small turn in the wheel at the same time to cause a large 
reaction. A rare moment." Michigan diverted a small portion of foster care money to Families 
First. How much money wil be saved remains to be seen. Famlies First is only two years old 
and is not yet funded to serve every family referred by child protective services. That is what 
Families First hopes to do next year, in at least one county. 
Saving money is not the most compellng reason to watch this program. The staff members are 
enthusiastic and the famlies appreciate being treated with respect. Staff members have 
experience in foster care, in child protective services, and other human service positions. One 
therapist said,

I worked in another agency before coming to Families First. Coming to Familes First 
was like a dream come true. In the past, the programs I worked for followed 
court-ordered goals. In Families First, we 
follow family-oriented goals. 
These familes may have had other children removed and may have been alenated from other 
social services. One therapist said, "Eighty percent of my famlies consider me as a frend. 
They don t hide anything from me. We get many calls from these famlies after the case has 
been closed." People are trated with basic respect at every level of the program, from 
administrator to consumer of services. 
For more information contact:  Familes First 
Family Prservation Initiative 
Offce of Children and Youth Services 
235 S. Grand Avenue 
O. Box 30037 
Lansing, MI 48909 
(517) 373-3465 
Susan Kelly, Program Coordinator  , "

HOSPITALITY HOUSE 
PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
HOSPITALITY HOUSE  SAN FRANCISCO  PRIVATE  RUNAWAY YOUTH  1967 
MAJOR SERVICES: COUNSELING , JOB TRAINING, REFERRALS, SHELTER 
When he was 16, Tom felt he had no choice but to run away from his family in New York. Tom 
repeatedly had been sexually abused by one of his brothers, and his father, a "religious fanatic, 
would not accept him because of his homosexuality. Being alone and homeless on the streets of 
San Francisco was not an easy existence either. When brought to Hospitality House, he was in 
crisis: he had developed a serious substance abuse problem, had resorted to street prostitution 
and was living in an abandoned car. According to his Hospitality House counselor, Tom "was on 
the path to an early death, either from a drug overdose or suicide. 
Such a tragedy was averted, however, through the help of Hospitality House. Hospitality House 
met Tom s immediate needs for food, shelter, and crisis counseling. Once stabilzed, Tom 
entered the residential program where he received job counseling and independent living skils 
him with an outside therapist and encouraged him to enroll in an education 
training. Staf linked 
program where he eared a high-school equivalency diploma. Because of the staff' s strong and 
persistent intervention, Tom finally confronted his substance abuse problem and enrolled in a 
basic 12-step program. Now ready to tae his final step to independent living, Tom entered the 
transitional living program where he lived in a residential hotel aparment parially subsidized by 
Hospitality House. 
It now has been over 4 years since Tom fIrst came to Hospitality House. Today, he is free from 
drugs and prostitution, supports himself with a full-time job, and lives in his own aparment. 
Although he has not needed any assistance from Hospitaity House in the past year and a half, he 
stil keeps in touch with staf who are almost like famly to him. As his counselor said  For 
almost 3 years, through all the ups and downs, Tom knew we always were here for him, and in 
the end that s what made the diference. 
Since its founding in 1967, Hospitality House has helped hundreds of homeless and runaway 
youth like Tom escape lives of prostitution, drgs, and crme, and make the transition to a stable 
living environment. Initially begun as a drop-in-center for youth, Hospitalty House is today a 
comprehensive youth service center that includes outreach, case management, individual and 
group counseling, emergency shelter, vocational counseling and job placement, independent 
ving skils training, and transitional housing. 
Like Tom, all Hospitaity House clients are runaway and homeless youth between the ages of 15 
and 21. Most come from outside the local area and have fled to San Francisco to escape familes 
where neglect and physical, sexual, and emotional abuse were the norm. They have been on the 
streets anywhere from a day to a few years. Lacking money, the support of frends and relatives, 
or job skills, they often fal prey to pimps and drg pushers. . Staf estimate that approximately 
50 percent have resorted to survival sex for food, shelter, money, drgs, or transportation.  , '
Recognizing that these youth are  agencies and reluctant to ask for 
distrstful of social service 
help, staff conduct outreach on the streets where homeless youth congregate. The outreach 
workers are young, and several were once street prostitutes themselves. They distrbute bleach 
and condoms and inform the youth about the services Hospitality House can provide. 
When they first come to Hospitaity House, many clients request only food or clothing. 
Providing this basic assistance is important, because it gives the kids an opportunity to observe 
and evaluate the program in a non-threatening, non-committa forum. Depending on their 
readiness to leave the streets, it may take anywhere from a few hours to a few months before 
clients are ready to take the next step to the Jobs Program or case management. In the meantime 
both voluntar and strctured activities are held in the lounge to provide an opportunity for kids 
sta. 
to know and 
trst the 
The Jobs Program stresses the importance of learing how to conduct ajobsearch and keeping a 
job as much as getting the job itself. Clients are rewarded for their efforts with vouchers for new 
clothing. Those not yet stable enough to begin a job search are offered the opportunity to do 
volunteer work on site. This gives the youth an important sense of accomplishment and 
acceptance. 
Case management helps clients define their goals and develop their own service plans that may 
include independent living, alternative placement, or famy reunification. Case managers also 
help clients obtain whatever services they' need, whether it be an identification card or medical 
and denta care. Just as importt as this concrete assistance, however, are the personal 
relationships the youth develop with their case managers. Case managers become support 
systems for the youth who know that they can drop in any time even when they just need 
tal 
someone to  to. 
A major step for many clients is entering the supervised housing unit. This shelter provides a 
safe, stable environment in which kids can begin to focus less on their immediate survival needs 
and more on personal growth and development. Clients must attend meetings and meet regularly 
with their case managers. They also receive independent living skils traiing which includes 
meal planning and preparation, personal hygiene, household maintenance, and conflct resolution. 
Clients who have steady jobs are eligible for the Independent Living Program. Hospitality 
House subsidizes the client s rent in a residential hotel room for up to 2 months and provides 
alar 
such basic necessities as pots, pans, eating utensils,  clocks, hot plates, and food. Clients 
and attend weekly independent living skills workshops on 
continue to meet regularly with staf 
budgeting, career development, aparment search, and roommate selection. They work with a 
counselor to plan their actual transition to independent living. 
Because Hospitality House realizes that not all clients wil be successful their first time in the 
retu 
program, it maintains an open door policy that allows clients to  at any time. It also 
provides ongoing support services for clients who have moved into stable living arangements. 
Hospitality House reports an 80 percent "stabilzation rate" for its housing program clients. This 
means that 120 days after leaving the program, the youth is in a stable living situation and not on  the street. A limited site review conducted by the City and .county of San Francisco found that 
Hospitality House was playing a positive role in diverting youth from prostitution, drg abuse, 
and other debilitating aspects of street life, and assisting them in achieving safe, stable, living 
situations. 
For more information contact:  Hospitality House 
146 Leavenworth Street 
San Francisco, CA 94102 
(415) 776-2102 
Ann O'Halloran, Program Director  ! '
IOWA DECATEGORIZATION OF CHILD WELFARE SERVICES 
PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
IOWA 
IOWA  STATE/COUNT  CHILD WELFARE CLIENTS  1988 
DE CATEGORIZATION 

MAOR SERVICES: COUNSELING. FOSTER CARE. HARD SERVICES 
Trying to find appropriate services for severely emotionally disturbed children can be like trying 
to fit a square peg into a round hole. Joey, a child so troubled that at age 7 he assaulted his father 
with a baseball bat and by age 9 had stolen 300 bicycles, proved to be a difficult client for the 
Polk County, Iowa, Deparment of Human Services to place in treatment. Iowa s restrctive limit 
on reimbursement to in-state providers discouraged treatment facilities from accepting severe, 
The only facility that would accept him was a detention school in 
expensive cases lie Joey. 
Texas which charged more than $600 a day. Under the traditional, categorized funding approach 
in Iowa, cases like Joey s emphasized the rigidity of the child welfare system. 
Frustration at the lack of flexibilty in child welfar services spured legislative action. In a 
yeardemonstration project, the 1987 legislation allowed 2 counties-Polk and Scott-
combine the monies from 32 separate funding streams into a single Child Welfare Fund. This 
process "decategorized" the funds. Each county s Child Welfare Fund compensates service 
providers for a great range of services, from foster car and juvenile institutional care to 
in-home, famly preservation services. By lifting categorical requirements on how money can be 
spent, the pooled resources allow local child welfar commttees greater discretion as to which 
services they can provide. Also importantly, the legislation required that the Deparent of 
Human Services (DHS), the juvenile courts, and the Board of Supervisors of each county work 
together closely to plan the decategorization process. 
Since the decategorization project emphasizes collective planning and decision-making at the 
community level, each county set up an elaborate commttee strcture composed of the 
legislatively-mandated representatives plus service providers, school distrcts, and concerned 
individuals. 
To date, the growth of a strong inter-agency cooperative effort has been the most beneficial result 
of the committee process. Offcials and service providers worked closely to identify gaps in 
services and develop cost-effective new services. Such cooperation also has enabled the 
development of individualized service plans for clients, because providers are now wiling to 
share responsibility for clients. 
Without this option of individualized planning for clients, 9-year-old Joey would have been 
placed in an expensive, Texas school, and his mother would have had to leave her job and 
relocate. Polk County was able to work out a less expensive alternative that involved the 
collaboration of two separate local providers. Currently, Joey is in an acute psychiatrc hospital 
for stabilization at $400 per day; later, he wil be placed in a nearby residential facility costing 
$124 per day. Without additional compensation from the Child Welfare Fund to supplement 
Medicaid' s reimbursement limit, the hospital would not have accepted Joey. Furthermore  ! .
without the agreements for mutual support between the hospita and the residential facility, 
neither would have accepted him. 
The goal of decategorization is to allow the funding of more flexible, better client-based services 
at a lower cost. The "  2 Program" is another example of this flexibilty at work. Under this 
retu 
program, children reside in group treatment homes during the week and  to their homes on 
weekends. A counselor makes in-home visits with the famlies at home on the weekends to help 
make the transition easier. The program also seeks to cut the costs of care by returning children 
to their families more quickly. 
A program such as "  2" was not possible before decategorization. Previously, the funding 
stream would not reimburse a group home for the empty beds on weekends past a limit of 
30 days. This practice discouraged service providers from letting the clients leave the group 
home. Under decategorization, the flexibility of the Child Welfare Fund allows DHS to 
reimburse providers for a porton of the cost of the empty beds on weekends and to pay for 
counseling services in the home. 
Even though decategorization has enabled the development of some effective new services, there 
is widespread disappointment among Polk County offcials and staf about the slow pace of the 
project s growth. During the year that decategorization has been in effect, relatively few new 
services have been developed and few clients have benefited diectly from the project. 
Specifically, in the last month of fiscal year 1990, only 3 percent of clients (46 out of 1433) 
received services specifically targeted by decategorization. 
Fear of change and an initial lack of trst between the public agencies and the providers were 
major hurdles in the development of decategorization. Committee collaboration and support of 
ale 
key individuals were vital in getting public agencies and service providers  to "buy in
" to 
stag 
the project. DHS also offered to "share the risk" with providers in  new services by 
promising to compensate for anticipated first-year costs. . 
It is too early to determe whether the decategorization project wil achieve all of its objectives. 
While questions remain concerning its long-term budget implications or the ability to replicate 
the project in another setting, decategorization certainly has the potential to promote a 
cooperative child welfare services community which works to improve services and to find 
lower cost alternatives for hard-to-serve clients. 
For more information contact:  Iowa Decategorization Project (Polk County) 
1200 University Avenue, Suite B 
Des Moines, IA 50314 
(515) 281-5090 
Deborah Westvold, Coordinator  LAFAYETTE COURTS FAMILY DEVELOPMENT CENTER

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
LAFAYETE COURTS 
FAMILY 
BALTIMORE  CITY  RESIDENTS OF SINGLE HOUSING PROJECT  1987 
DEVELOPMENT 
CENTER 
MAJOR SERVICES: COUNSELING , DAYCARE, MEDICAL SERVICES. REFERRALS 
Government-funded housing projects can be grm remiders of how poverty gnps many families 
living in America s inner cities. Lafayette Cours in Baltimore, Marland could be just another 
example. About 85 percent of the 805 familes living in the high rise development are on 
welfare and almost 50 percent of the adults did not complete high school. Of the 
2,400 residents, hal are under age 20 and suffer from low self-esteem and a bleak future outlook. 
Yet Lafayette Cours is unique. It is the only 1 of the 40 city housing developments to offer 
families a multiservice center withn the project. Among the services offered on-site by the 
Famy: Development Center are comprehensive long-term case management, a health clinic, 
developmenta child car services (including Head Star and full-day child care), adult education 
employment and job trning counseling and assistance, and programs targeting teenagers. All 
of these services can be seen from behind the fences enclosing Lafayette Courts ' apartment 
balconies. 
Center planners noticed that service networks in place before 1987 were inadequate for families 
within the projects. Services were poorly coordinated, with city agencies failing to communicate 
effectively. Service providers were often not located near the housing projects. The result for 
many famies was isolation, alenation from service delivery systems, and deterioration of the 
famly unit. To respond to this problem, city offcials decided that services should be accessible 
on location and specifically targeted to the famy unit. 
The case managers provide the glue that bonds the wide range of public services and resources 
available to Lafayette Cours famlies. They work with clients to develop both short- and 
long-term goals. In addition, they challenge clients with probing questions about problems. 
Everything comes out," stated one case manager. 
Case managers also serve as coaches and advocates for clients attempting to access outside 
service agencies. They have developed relationships with other agencies through networking 
and coach clients on what to ask and how to ask it when dealing with public agencies. " 
introduce people to common sense things they have not come up with on their own " said one 
manager. Case managers then contact agencies to alert them to a client s arval. "We...tell the 
DSS (Deparment of Social Services) worker to be nice and supportive. 
Locating services within the project has distinct advantages, both for families and for the case 
managers attempting to solve the  ntimes puzzling problems that may be 
diffcult and oft 
hindering a family s ability to function. "Because clients see me every day, they can talk to me 
at any time. If they were across the city, they wouldn t do it... I've sent people far away to 
programs and you lose trck of them. If they re close, they ll come in and talk " stated one case  manager. In addition, because the Center offers services directly, the case manager may find out 
about problems indirectly. "I found out about an individual who attempted suicide," said one 
case manager. "I didn't know about it until the (literacy program) teacher told me about it. 
Eventually this woman graduated from school. You feel better that you can find out (about the 
problem) and support the individual. 
One client s desire to improve her situation was enhanced by the comprehensive services offered 
by the Center. Marlyn, a young, single parent wi  five children, wanted to get her GED. 
Although the case manager helped get her childrn into day care, she pulled them out because 
she thought the program should be more strctued. The case manager explained that day care 
was intended neither to provide tutoring nor to be a substitute parnt. He managed to get the 
childrn back into the program, provided them medical car through the health clinic, and 
networked to fmd emergency foo and rent assistace. Maryn attended OED classes at the 
Center. Although she faied the GED once, she is now in her second year at college and is in a 
work-study program. She is giving a speech in one of her classes, appears confident, and dresses 
nicely. She has also become active in a parent group for the day care program at the center. 
Being able to offer day care dictly has brought many of the project s single parents into the

Center for help. Approximately 90 percent of the families are headed by single parents. By

offering full time day care, parents like Marlyn are then able to complete literacy programs

, located just two floors above the child car center. Then, when ready to work, they know that

their young childrn wil have subsidized before- and after-school care. 
progrs ar 
While many ambitious social service  hindered by lack of physical space, Center 
offcials have creatively resolved this issue since the Center opened., Perhaps most importantly, 
the Center obtained the use of two floors of a public school across the street in order to provide 
diect services. The school was planning to close the floors due to underenrollment, but in 
exchange for fmancing the necessar renovations, grted the Center use of the space to provide 
literacy, child care, and work programs at a minimal cost. In addition, because city agencies 
outstation staf for most of these programs, the Center can offer this wicle aray of services 
despite its small budget. 
City offcials stressed the importance of top-level city support and leadership in implementing 
the Center. One important element was the existence of a "superagency" created by the 
consolidation of the Deparment of Employment and the Baltimore Housing Authority in the 
mid-1980s. City offcials stressed that the efforts of the agency s director were invaluable. 
She...sold the idea to the mayor" said one official. Baltimore s current mayor is a solid 
supporter of the program and has attended block paries at the development to encourage people 
to use the Center s services. Top-level leadership also has assured that the agencies participating 
in the program work together. 
Despite all of the coordination and cooperation, center offcials admit that they have had 
diffculty offering programs to attract teenagers. Almost one-quarer of the residents in Lafayette 
Courts are from ages 12 to 20. "We don t know why they don t come in " said a city official. 
, The program director summed it up more directly: "The things available on the street are 
tempting to kids. They want it all-gold, Reeboks.... This is my biggest frustration. " Center  offcials hope that purchasing weight equipment wil get more teens off the street and into the 
Center. 
For more information contact:	 Lafayette Courts Family Development Center 
200 N. Aisquith Street 
Baltimore, MD 21202 
(301) 396-9321 
James Massey, Project Director  \ .
LIBERTY FAMILY RESOURCE CENTER 
PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
LIBERTY FAMILY
 BALTIMORE COUNT  COUNTY  BALTIMORE COUNTY RESIDENTS  1989 
RESOUCE CENTER 
MAJOR SERVICES: COUNSELING. MEDICAL SERVICES, REFERRALS 
Although the Hannah More office of the Baltimore County (Maryland) Deparment of Social 
Services (DSS) offce was not yet open, the line outside was well formed. When Mrs. Schwarz 
arved at 8:00 a.m., a county worker counted off the ftrst five people in line and told the rest that 
they could not been seen tody. They could call for an appointment to be seen in a couple of 
weeks or line' up again tomorrow. Mrs. Schwar left, unable even to talk to anyone. 
When residents elected a new County Executive in 1986, they paved the way for the ambitious 
electee to revamp the county s service delivery strcture radically. In the 4 years since bringing 
a "book" of initiatives into office, the County Executive has overseen the opening of 
2 famly-focused multiservice centers and has laid the framework for a countywide network of 
12 more centers designed to brig agencies together to serve people like Mrs. Schwartz 
comprehensively, without the failurs ilustrated by her previous experience. 
The fIrst center, on Liberty Road in the Nortwest section of the County, is a 32 000 square foot 
facilty mainly contaiing agencies which either relocated to the facilty or outstationed 
employees to handle basic services, such as intae. Mrs. Schwarz can now see a DSS worker 
who can ans  er her questions and assist her with the paperwork needed to receive county 
benefits. 
Famies  the center itself. This is especially 
seeking assistace can have most needs addressed at 
important because, in general, countywide transportation is poor. Whereas Mrs. Schwarz 
previously might have had to travel to several locations throughout the county to access different 
county services, the Liberty Center offers a wide aray of services within one building. These 
include health services, menta health counseling, emergency services (including eviction and 
foreclosure prevention and emergency food and clothing), assistance in applying for food stamps 
and public assistance, job trning and employment services, and substance abuse support 
, and tratment. 
groups, education
The cost of locating services in one center is surprisingly low, mainly because the multiservice 
centers are strctured to use existing services. County agencies are given offce space to 
outstation employees. Some, such as DSS, outstation only one worker on a par-time basis. On 
the other hand, the Deparment of Mental Health has numerous counselors, psychologists, and 
psychiatrsts on staff at the center. 
Libert Center staff stressed, however, that quality service delivery does not stem automatically 
from collocating services. Developing trst and gooo working relationships between agencies is 
critical to the success of any attempt to coordinate services. "We want the relationship to last 
even if (an) agency leaves (the Center)," a county official tated. County administrators and  Liberty Center staff both stressed that trust has evolved because center staff have developed 
good informal relationships. 
Because of the effective relationships developed among agencies at the Center, Liberty staff 
believe that everyone is much more responsive and wiling to provide services immediately to 
clients. According to one caseworker, the collocation allows personnel from different agencies 
to meet regularly to discuss clients, lear about new programs, and hold frank discussions about 
agency relationships. 
While certnly desirable and critical to the success of a multiservice center, agency cooperation 
alone wil not ensure the success of a new service delivery system. Service seekers must be 
aware of the services avaiable and have the abilty to access them. To ensure this, Family 
Resoure Center planners created client-centered Famly Help Teams in each center. These 
teams provide comprehensive screening, referr, advocacy, and follow-up for walk-in clients. 
The Help Team can dig into the bag of available services and come up with a suitable plan for 
the client. 
But the Help Team s role does not end there. "I take them down the hallway and introduce them 
(to referral agencies)," said one Help Team member. He stressed that even if the client 
appointment is not for another week, he wil take the client to the agency anyway to introduce 
them. The effect on the client s attitude is ogviously positive. "I see it in the client s eyes, the 
response that we get back," he added. 
An importt ingredient for treating famlies or individuals in crisis is flexibility. If an 
individual comes into a center on the verge of being evicted, merely completing public 
assistace forms wil do very litte for  s immediate needs or his confidence in the 
the client 
social service system. To address this need, the Liberty Center has given offce space to the 
Community Assistance Network (CAN), a private, nonprofit agency. Despite occupying only 
one smal offce, CAN offers what many public agencies often cannot: flexible, rapid response 
to emergency client situations. One caseworker stated that CAN manages to fil many traditional 
service gaps by offering immediate assistance with, for example, emergency food, payment for 
utility shutoffs, prescriptions, and evictions. 
In addition, each Family Help Team member is given a certain amount of 
discretionar funds to 
distrbute as he or she sees fit. The counselor may give vouchers for KMart or McDonalds, or 
may actually give money to a client. One man who was traveling from Texas to Indiana 
accidentally ended up in Baltimore, because his geography skills were limited. He only 
requested $17 to fill up his car with gas and said that he would be on his way. The Family Help 
Team counselor gave him the money and some McDonalds vouchers. "It was my decision to 
give him the money," said the counselor. "We get to make many decisions for ourselves. 
While some programs-such as substance abuse treatment-run at capacity, the Family Help 
Team s caseloads have been small. One Help Team member called this situation "frustrating, 
adding that it is difficult to establish a new program in an entirely new building. The Help Team 
at the Eastern Resource Center, recendy opened across the county, has been serving a greater 
number of clients, however.  For more information contact:	 Libert Family Resource Center 
Office of Family Resources 
611 Central Avenue 
Towson, MD 21204 
(301) 887-2001 
Ellen Yerman, Director  LITTLE SISTERS OF THE ASSUMPTION:

FAMILY HEALTH SERVICE INC.

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
LITTLE SISTERS OF 
EAST HARLEM  PRIVATE  EAST HARLEM RESIDENTS  1958 
THE ASSUMPTION 
MAOR SERVICES: COUNSELING, DAYCARE, EDUCATION, JO TRAINING, MEDICAL SERVICES, REFERRALS 
Walng down East 119th street in Spanish Harlem, one has to concentrate to find the Little 
Sisters of the Assumption Famly Health Service (PS). Without noticing the constant flow of 
neighborhoo famlies in and out of the basement effciency entrance, one would ignore the 
common brownstone in the middle of the block. From the outside to the inside, the building is 
very ordiar and unpretentious. Meeting the staff, one realizes that they are equally 
unassuming and down-to-ear. While the need for more space, computers, and staff are 
common complaits, tal of "their famlies" dominates discussions. 
Today the tal is about Mara. Mara and her two children have been the focus of a joint case 
study produced by PHS and Mount Sinai hospital. (Besides the fruitful referral relationship FHS 
has with the two community hospitals, Mount Sinai and Metropolitan, staff perform research on 
improving health in the community.) A Head Star Center referred Mara to FHS in 1987 after 
her husband, an IV-drg user with AIDS, committed suicide. Mara herself had just been 
diagnosed as having AIDS, and she was devastated by both her husband' s fate and her own 
prospects. She was without any real extended family support, and her health was declining as 
stress and AIDS took their toll. 
For the next 2 1/2 years PHS provided many services for Mara and her children. These services 
continue now, but without her, as she died in the beginning of 1990. When one listens to the 
people describe Mara with words like courageous, incredible, determined, and loving, one 
senses that not only have they lost a client, but also a frend. 
Mara s family had a diverse set of problems when they arved at FHS. The ent re organization 
worked intensely with Mara, her children, her father, and other related organizations to make the 
best out of the situation. The social workers and nurses went to the hospita with her as support 
went to the schools to ameliorate the children s behavioral problems and the ostracism they 
faced, went into her home to provide nursing and emotional and physical support, and acted as 
mediators with the hospital, the welfare agency, and her father. FRS counseled the children on 
both their father s death and on the imminent death of their mother. FHS also did the little things 
to make Mara s life happier, like day trps with and without her children and holiday dinners for 
her entire family. 
As a result, Mara died with dignity knowing that she did her best and that her children will 
survive in a new family with their grandfather. In this case, FRS' s support ilustrates their 
special services. The combination of the social work and nursing provided by the Certified 
Home Health Agency (CHHA) is a unique feature of FRS. The advocacy and commitment are 
impressive as well. The support given to Mara might sound extraordinar, but at FHS it is the 
norm.  The staf at FRS who became her famly are not only special, but also hard to find. FHS is 
comprised of 34 women and one man, most of whom have at least one master s degree. While a 
religious order founded FRS, only half of the staff are nuns, and the organization is 
non-sectaran. The nuns come from varous orders, and the lay people have equally diverse 
ethnic and professional backgrounds. Some of the staff were even clients in years past who now 
want to repay FRS. One "grandmother" in parcular now staffs the playroom and makes home 
visits, because FRS had helped her manage her daily life with her seven children years earlier. 
There is a real sense of community and family among the staff, and the clients acknowledge and 
appreciate the environment. As one client said, "I do not want to leave here. This is my home. 
Everyone from management down to social worker "knows" and cares about the specific needs 
of each famly. This team case management approach is most effective as referrals are easier and 
clients are more comfortble. Cases ar opened within 24 hours of referral and some cases span 
not only years but generations. Cases are not limited by time, eligibility requirements are not 
needed, and organizational quotas are nor used. The organization s only goal is the promotion of 
famly "health" in its broadest definition. 
The staff's dedication to produce this self-suffciency goes beyond their professional duties. 
Time clocks are not a consideration, and every problem is addressed. In motivating a client, one 
caseworker "banged on the door at 6:00 a.m. every morning for 5 weeks" to make sure the 
mother was up and would get the childrn to schoo1. The wilingness to help the client without 
regard to reimbursement or bureaucratic restrctions is readily apparent. In another family, a 
41-year-old man with AIDS desperately needed free time. Takng care of his diabetic mother 
who was recovering from an operation was a full tie job. Any other home health agency would 
not help since this was not an eligible "family." However, the CHH nurse quickly identified 
this famly s need, and the staf provided in-home care 8 hours each day at no cost to the family. 
The nurses in the CHH are a major intake point as they are trained to survey the family 
environment to discover more than just the family s physical health needs. 
Success to FRS is not measurd in statistical terms, b t from a different perspective. To 
enable" a family so they can begin to function with some pride is a major trumph to staff. They 
utilize the combination of their many integrated services and their reputation and place in the 
community to accomplish their goals. 
For more information contact:  Little Sisters of the Assumption 
Family Health Service, Inc. 
426 East 119th Street 
New York, NY 10035 
(212) 289-6484 
Sister Judy Garson, Co-Director  NEW JERSEY SCHOOL-BASED PROGRAM

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
NEW JERSEY 
SCHOOL-BASED  NEW JERSEY  STATE  TEENAGERS  1988 
PROGRAM 
MAJOR SERVICES: COUNSELING, JOB TRAINING, MEDICAL SERVICES, REFERRALS 
Bil is a 15-year-01d student in a New Jersey high school. His test results from elementar 
school suggest he is an extrmely bright student, but, unmotivated. He is failing most of his 
subjects, has fallen in with drg dealers, and is a major behavioral problem. Following an 
incident when he was caught fighting in the hallway shortly after staring the ninth grade, Bil 
was refen-ed to the New Jersey School-Based Youth Services Program. After interviewing Bil 
progr 
and his mother  staf found out that there is severe famly discord in his home, and his 
father violently abuses his mother. While Bil tests near the "superior" range intellectually, he is 
extremely ag~essive in school and withdrawn at home. 
Bil is tyical of clients who come to the attention of this unique program that provides seriously 
troubled adolescents with the opportunity to complete high school, go on to a job or higher 
education, and lead a mentaly and physically healthy life. The School-Based Program was 
established in 1988 to provide mental health, family counseling, health and employment services 
progr 
in schools to at-risk adolescents. The  is administered on a statewide basis by the 
Deparent of Human Resources (DHR). The DHR funds 29 sites in all 21 counties. These 
sites ar located in or near schools and provide students with "one-stop" shopping for services. 
Funding is offered only to communities that demonstrate the support and participation of a broad 
coalition of local community groups, teachers and parents, businesses, public agencies and 
school distrcts. 
The School-Based Program staff work as a team to guide and direct program clients. With 
someone lie Bil, staf provide counseling to the mother to get her out of a destructive 
relationship and therapy to Bil to work through his rage and disruptive tendencies. Since he is 
naturally so bright, he might be given a job tutoring younger kids in the elementary grades and 
the opportunity to ear money without resortng to drg dealing. Both State and local program 
staff feel that a multiprogr approach with linked services is essential to help Bil and other 
multiproblem teens. All local project staff get to know and build trst with the teenagers, jointly 
assess their needs and insure they are linked with direct services or referrals. Cross training is 
supplied so that staff can back up each other when someone is absent. As one youth counselor 
stated, "We get together and discuss our cases as a team beforehand; we dissect an individual. 
Our clients do not get an isolated service, they get joint services. 
Drew Altman, the former DHR Commissioner, was the major catalyst for the School-Based 
Program. Altman previously worked at the Robert Wood Johnson Foundation and knew how 
critical school-based preventive health programs could be to teens to prevent drg dependency, 
mental ilness, unwanted 
pregnancies, and sexually transmitted diseases. By integrating 
employment training, counseling and social services with the health component, Altman crafted 
a program to deal comprehensively with the health problems, drop outs, welfare dependency and
- lack of a skiled labor force. 
 . ...
Progr 
The target population for the School-Based  is youth aged 13-19 who are at risk of 
dropping out of school. While the program is open to anyone of any income, the State estimates 
that 75 percent of the parcipants are from inner city neighborhoods and 35 percent are from 
welfare famies. State funds provide a uniform core staff in each of the 29 sites: a project 
diector, a social worker, a genera youth counselor and a program assistant. Local projects 
supplement core staff with employment and family planning counselors, nurses, health workers, 
recreation specialists, and others. 
By providing these services in the schools and requirg the cooperation of school offcials, the 
State insurd that services reach school-aged teenagers where they spend most of their time. 
progrss are tied together. Teens who would be reluctant to take 
Social servces and educational 
a bus or drve to a distant site can get the counseling or service they need on site in their school. 
Andrea, for example, is a 17-year-old who has a 6-month-old son. She initially was going to 
drop out to car for her infant, but her School-Based Program offers on-site infant care. Andrea 
is able to leave her baby in an attactive, well-staffed nursery that has been decorated with 
furitu 
donated by community and business volunteers and goes to her classes in the same 
buildig. Both Andrea and her son s father are taking parenting classes. Because of the support 
she gets, she is now motivated to finish high school andthen study to become a nurse. 
In most sites, the School-Based Program has the support of the educational establishment. The 
pricipal of a large urban high school was initially resistant to having the program in his school 
I fraly 
but in time became a staunch supporter: " had to admit I could not deal with the 
problems kids have now, and my teachers could not deal with them. Now I see the program as a 
major support system essential if the kids are to stay in school and succeed. 
One of the more impressive features of the School-Based Program is the involvement of private 
industr. A number of corporations, such as AT&T and Johnson and Johnson, have implemented 
a mentorig program. Corporate employees adopt a teenager enrolled in the School-Based 
Program, develop a friendship and help the teenager though tutoring and counseling on career 
. and academic plans. The mentors also serve as positive role models for students and their 
parents. 
For more information contact:  New Jersey School-Based Youth Services Program 
Capital Place One 
222 South Waren Street 
Trenton, NJ 08625 
(609) 292-1617 
Edward Tetelman, Director Legal & Regulatory Affairs  .. ...---.,"
PROJECT GIANT STEP

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
PRaJECT GIANT  NYC  CIT  FAMILIES WtCHILD AGED 4  1986 
STEP 
MAOR SERVICES: COUNSELING , DAYCARE , EDUCATION , REFERRALS 
Letitia and Alfredo moved to New York City from the Dominican Republic 18 months ago to 
escape the povert and lack of opportunity in their homeland. They have 4 children, including 
year old Arlette. Letitia has worked as a nuring assistat, but Alfredo has been parially 
paralyzed for 3 years with a back injur from working on the docks. The family does not speak 
English very well. In addition, Arlette has a major speech defect. In the fall of 1989, Arlette 
enrolled in Project Giant Step. 
Begun in 1986, Project Giant Step is a half-day comprehensive preschool program for 4-year old 
Modeled on Head Star, it combines developmental and educational 
children and their famlies. 
experience for childrn with support services for familes and a program to involve parents in 
their children s education. Project Giant Step gives first priority to economically and 
educationaly disadvantaged famlies.

When Arlett enrolled, Project Giant Step staf interviewed Letitia extensively to assess the 
health, psychological, and social needs of the entire family. Teachers observed Arlette in 
strctured play and noted her speech problem. Arlette stared c1asses-designed to promote her 
social, emotional, creative, and physical growth-with 19 other children. The teachers gave 
Letitia good ideas on how to care for her children and husband without being overwhelmed. The 
famly received health examnations, Letitia enrolled in well baby and nutrtion classes, and 
Arlette and Alfredo were referrd for specialized treatment. The social worker gave Letitia 
needed information about services avaiable for her handicapped husband. The family assistant 
helped Letitia apply to Supplementa Securty Income (SSI) for Alfredo and helped the family 
get food staps. 
All of the Project Giant Step staf who worked with Letitia and her family were located in her 
neighborhood school, the same school Arlette wil attend when she stars kindergaren. Some of 
the services the family needed were provided through referrals to outside agencies. The staff 
made appointments for the family, followed through to see that the appointments were kept, and 
actually accompanied Alfredo and Letitia to an SSI eligibilty determnation appointment. 
Arlette is doing well in her classes, and the family is now under much less stress and shows a 
better chance of succeeding. 
Project Giant Step was initiated in New York City the mid-1980s because of concerns about an 
Only 65 percent 
unacceptably high dropout rate and a burgeoning special education population. 
of students finished high school, and about 60 percent of those referred to special education 
never rejoined the maistream. Such conditions could affect the City s economic renewal. 
Educators and policy makers in New York were aware that quality programs for 4-year-olds 
result in significant improvements keeping children at grade level, out of special education and 
in school until they graduate. In 1986, Mayor Edward Koch formed a Commission on Early  / . 
. ...----...
Childhood Education. Their 1986 report, "Take a Giant Step," set the parameters for the 
program: 
Children who have attended quality early childhood programs, with health 
nutrition and social services, enter school healthier, better fed and with parents 
who are better equipped to support their educational development. 
Project Giant Step has a dual admnistrtion. About half of the centers are located in public 
schools and operated by the Board of Education (BOE). The rest are located in day care or 
multipurose community centers funded by the Agency for Child Development (ACD), which 
also operates city-sponsored Head Star and day care programs. The 1986 Commission 
recommended dual admnistrtion because both BOE and ACD operated early childhood 
programs, and the Commssion wanted to build on existing capabilities to give parents a choice 
between a classroom settig or a community center setting. The two agencies developed 
common systems of reportg and monitoring, common in-service trning, and a common 
evaluation approach. 
Inherent in Project Giant Step is the philosophy that integration of a well-developed currculum 
with social services, parent involvement, health education and nutrtion is necessar for positive 
results. As par of their evaluation of Project Giant Step, Abt Associates is looking at cost 
effectiveness issues. Abt s preliminar work shows that "children enrolled in Project Giant Step 
demonstrated substantial program year gains in a preschool inventory which were greater than 
gains on the same test by children in other comparable early childhood programs. 
Curently, Project Giant Step is undergoing major changes in funding and direction. It 
essentially has been replaced in the public schools with a less comprehensive pre-school 
ta 
program. Orgially, New York City funded Project Giant Step entiely from city  levies. 
Driven by a major fiscal crisis durg the summer of 1990, the city negotiated for New York 
State to pick up funding of the BOE porton of Project Giant Step. The BOE program is now 
called the "New York State Pre-Kindergaren Program" and has reduced classroom hours, 
eliminated the famiy worker position, and reduced staff training. Although program direction 
and coordination by the mayor s office is also significantly less, the ACD component continues 
largely unchanged. 
For more information contact:	 Project Giant Step

Human Resources Administration

" Agency for Child Development 
240 Church Street 
New York, NY 10013 
(718) 260-6973 
Helen Hawkins, Director  .. .._.--
YOUTH ADVOCATES

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
YOUTH ADVOCATES  SAN FRANCISCO  PRIVATE  RUNAWAY YOUTH  1969 
MAJOR SERVICES: COUNSELING. EDUCATION , MEDICAL SERVICES, REFERRALS, SHELTER 
For over 20 years, Youth Advocates has been at the forefront of providing innovative, 
community-based servces to at-risk teens and their famlies in California s San Francisco and 
Marn counties. Orginally begun as one the nation s first community-based shelters for 
runaway and homeless youth, Youth Advocates today operates two crisis shelters, a longer-term 
shelter for youth who ar awaitig pennanent placement by the Juvenile Cour, and an innovative 
Prgr  trs 
Teen mv Education and Prvention  which  teens to be health educators. 
Tony is tyical of the teens who come to Youth Advocates for help. The victim of sexual abuse 
by his father, Tony was raised by his heroin-addicted mother and stepfather. There were frequent 
famly fights, and, for Tony, homelife was an almost constat source of tension. Not 
surprisingly, Tony was an alcoholic by the tie he became a teenager, and soon was staying out 
late at night and skipping school. At age 15, Tony ran away from home. 
Like Tony, most of the teens who come to Youth Advocates for help are runaway or homeless 
youth between ages 12 and 18. While their family histories var, alost all share the experience 
of stressful home lives. Approximately 40 percent have suffered physical or sexual abuse, and 
more than 25 percent report drg and/or alcohol abuse by their parents. "Most of our kids are 
very likeable and bright, but many ar at risk because of chronic problems at home," said the 
Executive Director. "Our goal is to provide sensitive and carng support. Without this, many of 
our clients would be forced on the streets for surival and some would wind up as delinquents. 
Two beliefs lie at the hear of Youth Advoca  ' programs. The first is Youth Advocates 
commtment to providig as complete a contiuum of services as possible, and the second is the 
belief that these services are most effective when provided in home-like, community-based 
settings rather than in juvenile halls, institutions, or through court processes. 
Through extensive use of collocation and outstationing, Youth Advocates is able to provide a 
wide continuum of services which rage from prevention to crisis intervention to stabilization 
and growth. Youth Advocates' two crisis shelters meet youth' s immediate needs for food 
clothing, shelter, and crisis counseling. San Francisco s Probation, Public Health, and Social 
Service Deparments outstation staff at The City s crisis shelter. Most youth stay in the crisis 
shelters only a few days before they are reunited with their families. Following reunification 
high-risk youth and their families can continue to receive up to 4 months of aftercare counseling 
and case management. 
The long-term shelter also uses collocation and outstationing. In addition to providing food 
clothing, lodging, and counseling, the shelter has an on-site classroom that is staffed by an 
outstationed public school teacher. Transportation is available so that its youth can access all of 
the collocated services available at the nearby crisis shelter.  . ...--
Youth Advocates staf are convinced that collocation and outstationing have provided major 
benefits for clients. Perhaps the two most important benefits are that they immediately provide 
clients with access to services and help prevent the youth from "getting lost in the shuffe. " The 
arangements also allow the agency to provide a more complete continuum of services. This is 
important, staf emphasize, because many individual services would not be effective if they were 
not accompanied by other services. For example, clients would not be in a condition to benefit 
from counseling if the agency did not also meet their more basic needs for foqd, shelter, and 
famly reunification services would be less effective if they were not 
medical care. Simlarly, 
followed with an aftercare counseling program. Collocation and outstationing also provide staff 
with more complete information about a client. Different staf (e.g., counselor, probation officer 
public health nurse) who serve the same client work in the same location and develop close 
workig  and outstationing help cut through red tape 
relationships. Staf believe that collocation 
and lessen tur battes with other agencies. 
ar 
Many of these services  alternatives to services that otherwise would be provided by San 
Francisco and Marn counties. For example, both counties have contracted out with Youth 
priar 
Advocates' crisis shelters to serve as the  facilties for youth who are runaways or beyond 
parenta control (status offenders). Under the contracts, police bring all runaways they identify 
to the crisis shelters for intake and possible shelter. Since 1989, San Francisco also has 
contracted with Youth Advocates' long-term shelter to provide care for youth who are awaiting 
permanent placement by the Juvenile Court. These youth, who have not committed any crimes, 
previously were housed at San Fracisco s juvenile detention facilty. 
Youth Advocates ' staf adamantly believe that these contracts have gready improved services for 
runaway and homeless youth and their famlies. They are convinced that Youth Advocates is 
more client-oriented, comprehensive, and flexible than a public agency because it is not bound 
by a categorical mission, legal mandates, and other bureaucratic restrctions. The staff also 
believe Youth Advocates' services are more effective, because they are provided in 
community-based, home-like settings, which are more stable and nurturing environments for 
youth than large public, bureaucratic institutions. 
Thanks to Youth Advocates, the future today looks bright for Tony and his family. With the help 
of family counseling, Tony successfully has been reunited with his famly and their relationships 
have improved. Individual counseling has helped Tony deal with his history of sexual abuse and 
other personal problems and his self-esteem and body image have improved greatly. Counseling 
also forced Tony to confront his alcohol problem, and he enrolled in a teen alcohol program. 
Tony has been sober for the past several months, no longer stays out late at nights, and is doing 
well in school. Like hundreds of other youth, Youth Advocates has given Tony a new start in life. 
For more information contact:  Youth Advocates 
285 12th Avenue 
San Francisco, CA 94118 
(415) 668-2622 
Bruce Fisher, Executive Director  YOUTHCARE

PROGRAM  LOCATION  ADMINISTERED  PRIMARY CLIENTELE  SINCE 
YOUTHCARE  SEAffE  PRIVATE  RUNAWAY YOUTH  1974 
MAJOR SERVICES: COUNSELING. EDUCATION , MEDICAL SERVICES, REFERRALS. SHELTER 
Jane, now 19, was abandoned by her famly as a baby. She suffers from epilepsy, diagnosed 
from a history of severe beatigs. Adopted at age 2, she was abandoned again at 13 when her 
adoptive parents beat her for the last tie and then moved. After multiple foster care placements 
and involvement in marjuana and other drgs, she hit the streets. Finally, she discovered 
Seatde s YouthCare and found the help she needed. Now she is studying for an associate degree 
in child development at the community college and works in the YMCA' s day care center. She 
thinks of YouthCar as her famy. 
Most of Youth Car s clients ra away from dysfunctional home situations; many had endured 
physical and sexual abuse. Their prospects of famly reunification are dismal to nonexistent. As 
the executive diector noted, "Most of our kids do not have a famly." In order to survive on the 
streets, they resort to any means, including prostitution, shoplifting, and other criminal activities. 
cert 
Unfortunately, street life holds a  glamour for these abused and hardened youth, most of 
whom  The longer they live on the streets, the more difficult it is to leave. 
distrst adults. 
Founded in 1974, YouthCare has an open door policy. Not only has it reached young people no 
one else wants to thin about, but also it has offered them a second chance. The environment is 
nonjudgmenta. The kids can drop their hard street facade once past YouthCare s doors. Each 
client requires concentrated attention with a holistic approach to care. YouthCare staff work 
on-site with professionals outstationed from other agencies, such as the King County Health 
Deparent and Seattle Public Schools. At the same time, YouthCare staff work regularly at 
YouthCar has a rich network of interagency 
other agencies, such as juvenile detention. 
agreements and informal workig relationships to help their kids and run a smooth program. 
Most of the young people need nurturng; the relationships with their case workers become 
therapeutic. Youth Care gives them time and space to decide for themselves if they want to 
receive help. They even can choose their caseworkers. 
In addition to being nonjudgmental, caseworkers must be creative. For example, Kim, a 
, 19-year-old prostitute came to YouthCare wanting to continue prostituting, but to move to a nicer 
area with access to health care and safer customers. The caseworker knew she would lose Kim if 
she did not weave between what Kim wanted and what was best for her. Thus, the caseworker 
aranged to rent an aparent in a safer area and convinced Kim to take modeling classes at the 
community college, even though she continued to prostitute. Kim soon began to view herself 
more positively, and now is taking journalism courses. Most importantly, she has stopped 
prostituting. 
Youth Care offers three different shelter environments depending on the age and immediate needs 
of the young people. The emergency crisis shelter with its 14-day-stay limitation began years 
ago through the efforts of dedicated volunteers and now has 10 full-time staff. Two other  ... 
.. ...---...
.I 
APPENDIX 

UNIQUE SERVICE DELIVERY PRACTICES 
New Jersey s School-Based Program has enlisted a number of corporations, such as 
AT&T and Johnson and Johnson, to paricipate in a teen mentoring program. 
Corporate employees "adopt" a teenager enrolled in the School-Based Program 
develop a frendship, and help the teenager through tutoring and counseling on career 
and academic plans. The mentors also serve as positive role models for students and 
their parents. 
Avance s parenting program goes into client homes to videotape parent and child 
vance plays the videotapes in front of the entire class of parents in 
interaction. A 
order to ilustrte good and bad parenting techniques. A vance also offers toymaking 
classes and shows parents how to use the toys to increase their children 
developmental skills. 
Little Sisters of the Assumption aranges trps and retreats so single parents can 
express their individuality and form frendships with other parents. One staff member 
claimed that these retreats have given single mothers an opportunity to share 
parcularly emotional experiences. Little Sisters also runs a "Grandmother 
progr, 
which offers in-home assistance with day-to-day organization skils, home 
management, neo-nata care, or just companionship and support. These services are 
provided by six actual grandmothers, some of whom were helped as clients 
themselves in earlier years. 
Lafayette Cours Famy Development Center offers a free, "no-questions-asked" 
drop-in center for individuals hesitant to tal to a case manager. Individuals may 
simply wal  center-which is furished much like an apartment-to watch 
into the 
television, cook a meal, do laundr, or play cards. The rationale is to make 
individuals feel more comfortable coming into the center so they eventually might 
feel comfortable enough to talk with a case manager about their problems. 
Youth Advocates set up a classroom on-site at one of its shelters for children awaiting 
cour placement. Classes are taught by a public school teacher provided by the city. 
One product of Iowa s decategorization is the "  2" program, in which youths at risk 
of permanent out-of-home placement reside in a group home 5 days a week and 
spend weekends with their families. A counselor visits the family s home on 
weekends to conduct counseling and teach parenting skils. Once a child has been 
returned to the family, the program provides aftercare counseling.  , . ...-.-