. .. 

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 

Ii\rdm 

JANUARY 1991 
. ...

..

.. 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 

Secretar of HHS of progr 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 

Related Reports: 
 Dysfunctional Families in the Head Star Program: Meeting the Challenge 

(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. " L
 --I( 

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. 
-f, ..t, 

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 

success. Public-private cooperation is an especially effective means for integrating services. 

, 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . .. 

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 

Avance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACenter for Successful Child Development

ConServe . . . . . . . . . . . . . . . . . . . . . . . A­


. . . . . . . . . . . 

Families First. . . . . . . . . . . . . . . . . . . . . AHospitality House . . . . . . . . . . . . . . . . AIowa Decategorization ............................................... A-


Lafayette Cours Famly Development Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ALiberty Family Resource Center. . . . . 

Little Sisters of the Assumption . . . . . A-


New Jersey School-Based Program . . AProject Giant Step . . . . . . . . . . . . . . . A 

Youth Advocates . . . . . . . . . . . . AYouthCare ........................................................ 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; 

( c) the provision of a comprehensive range of services locally; and (d) the rational 

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-Because there are many diverse ways to integrate services 

we purosefully selected initiatives that represented a varety of different approaches. 

Geographic balance-While we attempted to include initiatives from all major 

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-We deliberately sought a mix of public and private initiatives. 

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.


FIGURE 1: DESCRIPTIONS OF SELECTED SITES 

PROG LOCTION ADMrS' PRIY MAOR SINCE SERVICES 

AVANCE SAN ANONIO PR A'r FAM W/ CH 0 TO 3 1973


CE FOR SUCCESFU CHCAGO PRIVATE PAM WI CH 0 TO S CH DEVPME C, D, E. M, R 1987
 UVG IN HOUSIG PROJE 

CONSERVE PRATE HOMBS FAM . R, RS 1986 

FAM FIST MICHGA STA'r FAM 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 

LAAYE COURTS FAMY BALTIORE REIDEN OF SINGLE 1987 DEVOPME HOUSING PROJE C, D. M. R 

UBERTY FAMY BALTIORE COUN BALTIORE COUN 1989 REOURCE COUN REENS 

LI SISTE EAST PRVA'r EAT HA REIDEN , D, E. , R 1958 OF TH ASSUMON 

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 

KEY TO SERVICES


C-COUSELING E-EDUCATlONAL SERVICE M-MEICAL SERVICES RS-RENT SUBSIDY 

D-DAYCA F-FOST CA J-JOB TRG R-RE S-SHETE 

H-HA/CONCR SERVICE (ICLUDES HOUSEKING. HOME MACE 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. 

Administration. Of the 13 organizations, 7 are private social service agencies and 6 are public 

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 

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. 

Impetus for integrating services. 


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 

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. 

Budget andfunding. 

. .

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 

Specifically mentioned as current and/or former funding sources. 

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. 

Agency sizes. 
 The size of the agencies vares in terms of (1) the number of clients served, (2) the 

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 and eligibility criteria. Alll3 agencies target specific populations. For 

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 

locations were selected to increase access and convenience for clients. Service settings include 

Service locations. 


(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 

000 0
 000 tJ 	 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. 

Staffng. Stafing vares tremendously among the agencies. For example, ConServe exclusively 

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. 
 Case management generaly refers to the assignment of clients to staff 

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. 
 Interagency agreements are both formal and informal. They include 

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. Collocation refers to the location of multiple services and/or service providers at 

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 

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. 

Coapplicationlcoeligibility procedures. 


Noncategoricalfunding. Noncategorical or decategorized funding allows the service provider 

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. 

Program and agency consolidation. 
 This entails the consolidation of two or more formerly 

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 

are internal barers," commented one offcial. "Social workers like to operate in a certain way; 

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 are limited in staff We need more people for extended services; there is a waiting list 

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 

agencies specifically stated that low salares made it dicult 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. " Officials from one agency remarked that the 

shortage of shelter beds in their city is so great that they had to distrbute 200 sleeping bags to 

help keep homeless youth war 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 

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. 

Staff persistence and dedication. 


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 

preserve famlies. Supervisors car 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 

for her clients. "I beg my professional frends to take my kids or find friends of theirs 

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 

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. 

Discretionary funding. 

, . , 

,

Effective relationships. 
 Almost all 13 agencies stated that developing effective working 

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 

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. 

Strong political leadership and central coordination. 


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 skils as common client problems. 

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 

services by cutting through red tape and lessening tu 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 

fragmented. We would miss identifing many of the problems that our families have. 

we don t know those problems, the client wil not be helped. Ifwe had 10 independent

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, 

Kids have multiple service needs with multiple providers. Therefore a case manager 

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. 

SUCCESS DEPENDS UPON INTERAGENCY COOPERATION 

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 

limited, but it creates a war atmosphere instead of a crowded feeling. Avance vans pull up 

briging mothers to classes from their homes in the housing project and the surundig 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 

the importance of each mother tang 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 

interaction with her child. Avance staff make two monthly visits to each families ' home where 

they videotape mothers playing and talking to their children. Back in class, mothers get a chance parenting. 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 

a tral basis, priarly to give her the job experience she desperately needed on her resume. She 

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 

discover a new value and capabilty in themselves. Avance works priary 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 

for infants to 2-year-01ds. To be eligible, the mother must go to school, work, or both. The day 

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 

. collective feeling, "We all believe there should be more centers like this one. 

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' s abilty to help a client. In addition, being a small agency is 

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 

managers refer famlies. Mark was able to benefit pary because ConServe has developed both 

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 

training. Staf linked him with an outside therapist and encouraged him to enroll in an education 

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 distrstful of social service agencies and reluctant to ask for 

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 

to know and trst the sta. 

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 

someone to tal 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 

such basic necessities as pots, pans, eating utensils, alar clocks, hot plates, and food. Clients 

continue to meet regularly with staf and attend weekly independent living skills workshops on 

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 

program, it maintains an open door policy that allows clients to retu 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, 

expensive cases lie Joey. The only facility that would accept him was a detention school in 

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 Scottcombine 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 

program, children reside in group treatment homes during the week and retu 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 

key individuals were vital in getting public agencies and service providers ale to "buy in" to 

the project. DHS also offered to "share the risk" with providers in stag 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 

DEVELOPMENT BALTIMORE CITY RESIDENTS OF SINGLE HOUSING PROJECT 1987 

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 diffcult and oft ntimes puzzling problems that may be 

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. 

While many ambitious social service progrs ar 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 seeking assistace can have most needs addressed at the center itself. This is especially 

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 

groups, education, and tratment. 

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 the client s immediate needs or his confidence in the 

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 

and his mother progr 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 

in schools to at-risk adolescents. The progr 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. 

. ...

The target population for the School-Based Progr 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. 

Social servces and educational progrss are tied together. Teens who would be reluctant to take 

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 

but in time became a staunch supporter: "I fraly 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 

children and their famlies. Modeled on Head Star, it combines developmental and educational 

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 

unacceptably high dropout rate and a burgeoning special education population. Only 65 percent 

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 

program. Orgially, New York City funded Project Giant Step entiely from city ta 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 

Teen mv Education and Prvention Prgr which trs 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 

medical care. Simlarly, famly reunification services would be less effective if they were not 

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 relationships. Staf believe that collocation and outstationing help cut through red tape 

and lessen tur battes with other agencies. 

Many of these services ar alternatives to services that otherwise would be provided by San 

Francisco and Marn counties. For example, both counties have contracted out with Youth 

Advocates' crisis shelters to serve as the priar 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. 

Unfortunately, street life holds a cert glamour for these abused and hardened youth, most of 

whom distrst adults. The longer they live on the streets, the more difficult it is to leave. 

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 

other agencies, such as juvenile detention. YouthCar has a rich network of interagency 

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 

interaction. A vance plays the videotapes in front of the entire class of parents in 

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 into the center-which is furished much like an apartment-to watch 

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. 
, . ...

.