BPD Update Online, Fall 2008

Service Integration and Unification of the Profession: A Historical Perspective

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Carol J. Williams

Historical Perspective on Service Integration

In the mid 1970’s the author conducted research on the Organization and Dynamics of Social Service Delivery in New Jersey, which was continued in the author’s doctoral dissertation, Service integration in theory and practice:  an analysis of the concept and of its application to the interorganizational interactions of
New Jersey’s social service agencies (Williams, 1981).  At that time, there was particular concern in the State of New Jersey surrounding the issues of gaps, duplication, and fragmentation of services. 

Specifically, the 1976-1979 study, published by the County and Municipal Government Study Commission of the New Jersey State Legislature, examined the structure of service delivery in
New Jersey, and addressed a number of problems and issues related to that structure.  The motivation for the above study was the decrease in funding available for social services and the desire to use available funds in the best way possible.  In this way, the context of this study was very similar to the context in which we find ourselves today.

As part of the 1976-1979 study, in person interviews were conducted with the Directors of 1395 individual
New Jersey social service agencies.  Agency services, sources of funding, and inter-organizational relationships were examined in depth.  The original study took three years to complete, and produced a very comprehensive analysis of a statewide social service system.

The author’s 1980 publication identified different ways in which agencies had integrated their services: 

  • merger (where the identify of former member organizations is lost)
  • federation/confederation (where member organizations retain their separate identities, but create a formal coordinative umbrella agency)
  • joint services
  • contracts to purchase or provide services
  • co-location (sharing common physical space, but remaining administratively separate, as in a "one stop" center)
  • non-contractual purchase of service
  • coordinative meetings
  • referrals

These mechanisms of service integration differed in the degree of centralization that they utilized.  There was also a difference in the degree of formalization among the different mechanisms of integration (Williams, 1981).  Braeger and Holloway (1978) saw both centralization and formalization as continua along which to analyze organizational structure. When both of these variables are examined simultaneously as characteristics of service integration mechanisms, the following matrix emerges:

Centralization and Formalization

The following interrelationships were documented by 1395 New Jersey agency directors interviewed in the 1970’s. 

Agencies reported the number of other agencies with which they shared Decentralized/Informal contacts.  The averages were:

Agencies To Which You Make Referrals = 3.96

Agencies With Which You Exchange Information = 1.75

Agencies From Which You Receive Referrals = 1.19

Agencies With Which You Have Regular Coordinative Meetings = 1.16

Agencies To Which You Send Publicity = 1.11

Agencies With Which You Share Board Members = 1.05

Agencies With Which You Have Regular Case Conferences = .85

They also reported the average number of decentralized/formal relationships they had.  The averages were:

Number of Contracts to Provide Services = .54

Number of Contracts to Purchase Services = .33

Number of Contracts to Share Resources = .27

Only one instance of merger and two instances of agency co-location were identified in the entire study.  The two instances of co-location were countywide “one stop human service centers”.  Although there were no formal contracts between the co-located agencies, their location in a single building made it much easier to clients to have access to services.  A referral consisted of walking down the hall rather than writing a letter. 

The one merged agency was formed by two maternity homes, both of which had legacies and neither of which was attracting clients.  The two maternity homes merged and formed a powerful statewide child advocacy agency, the Association for Children of New Jersey.

respondents to the 1979 survey, which had centralized its social services under one umbrella agency, noted that although the previously separate agencies had been merged, differences still existed among the divisions of the umbrella agency (Williams, 1979). 

Unfortunately, no other questions about merger or confederation were included in the 1979 study.  Regardless of the tendency for theory in the 1970’s to stress centralized, formal mechanisms of service integration, data gathered in 1979 clearly demonstrate that informal, decentralized mechanisms were the tools actually being used by most agencies.

While most early efforts in service integration focused on top-down models, it is interesting to note that as early as 1978, Katz (1978) discussed three models:  the detached worker model, the central authority model, and the client-centered decentralized model, only one of which emphasized centralization.  Likewise, early efforts for service integration in
Pennsylvania were decentralized at the county level.  (Perlmutter, Richan, Weirich, 1979) 

In the 1990’s, after an absence of ten years, the issue of service integration began to resurface in the literature.  Ezell and Patti (1990) examined service integration efforts in six states, including
Delaware, and focused on issues of comprehensiveness and centralization. 

By contrast, Waldfogel (1997) wrote about the Maryland Systems Reform Initiative, an effort to integrate services, governance and financing by using a bottom-up approach.  In actuality, much of the literature on service integration from the 1990’s favored a bottom-up approach as opposed to the top-down strategies touted in the 1970’s. 

Social work, in the new millennium once again faces the reality of substantial cuts in available resources, making the issues of service gaps, duplication, and fragmentation as timely today as they were 30 years ago. 

The author conducted a 2003 follow-up study intended to revisit the issues of the 1979
New Jersey study.  It employed a scaled down version of the original survey instrument, but focused on a national convenience sample of state agencies and large private nonprofit agencies rather than attempting to interview the entire population of agency directors in one state, as was done in New Jersey in 1979.  Thirty respondents, including administrators in the New Jersey Department of Human Services and members of the National Network for Social Work Managers, were the respondents.  Respondents to the 2003 survey represented agencies that were much larger and more complex. 

Agencies reported the number of other agencies with which they shared Decentralized/Informal contacts.  The averages were:

Agencies With Which You Have Regular Case Conferences = 189

Agencies With Which You Exchange Information = 150

Agencies To Which You Send Publicity = 149

Agencies With Which You Have Regular Coordinative Meetings = 38

Agencies With Which You Share Board Members = 16

These findings mirror the pattern found in 1979, except for the item on shared board members.  The relatively small average number of board members shared is explained by the fact that the New Jersey Department of Human Services has no Board. 

Respondents also reported the average number of decentralized/formal relationships they had.  Those averages were:

Number of Contracts to Provide Services = 31

Number of Contracts to Purchase Services = 17

Number of Contracts to Share Resources = 17

As expected, the larger agencies interviewed in 2003 had larger numbers of contacts in each category.  However, the pattern of contacts between the two groups is similar, with the number of informal connections being greater than the number of formal connections.  Informal relationships among agencies are thus worthy of more intense examination.

Horvath and Morrison (2006) have provided a recent analysis of service integration efforts in child welfare services.  They note that “too often establishment of collaborative structure and systems are mistaken for the realization of collaborative activity (p. 66)” They note the importance of a collaborative process in moving toward a collaborative structure.  They reference Hamblin’s 2001 work on organizational change and development, which notes that frequent failed attempts at integration have occurred when the people issues have been neglected in favor of the structural issues.  This is an important lesson for us as we continue to move in the direction of unification.

Applying this to Social Work Education

If we compare the results of the above review to what is happening today in social work education, it is noteworthy that we have already made many steps in the direction of unification.  Our institutions regularly make and receive referrals with other social work education programs and attend regular coordinative meetings.  We exchange information and publicity, and there are contracts that link many of our educational institutions. 

In recent years, we have achieved co-location for CSWE, BPD, and NADD, with all three agencies having a common central location in the CSWE Office.  This is an important forward step in the direction of unification and should be recognized as such.

We have established the Wingspread group, which is composed of the leaders of many of our social work organizations, and which is examining options for further integration of social work the profession.  Recently, CSWE has established new Councils to represent several of the major constituency groups within social work education.

A next logical step in the direction of unification would be the development of a federated structure in which each organization might retain its autonomy, but through which social work educators might speak with one voice. 


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