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
With Which You Exchange Information = 1.75
From Which You Receive Referrals = 1.19
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 =
They also reported the average number of decentralized/formal
relationships they had. The averages were:
of Contracts to Provide Services = .54
of Contracts to Purchase Services = .33
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.
Delaware 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.
the number of other agencies with which they shared Decentralized/Informal contacts. The averages
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
Agencies With Which You Share Board Members = 16
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
Number of Contracts to Provide Services = 31
Number of Contracts to Purchase Services = 17
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.
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
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.
BIBLIOGRAPHY ON SERVICE INTEGRATION
Adams, P; Nelson, K. “Reclaiming
community: an integrative approach to human services”. Administration in Social
Work. 21(3/4): 67-81, 1997.
Austin, M; Prince, J. “The implications
of managed care and welfare reform for the integration of health and welfare services”. Journal
of Health and Social Policy. 18(2): 1-19, 2003.
G.; Holloway, S. Changing Human Service Organizations. Free Press, New York: 1978.
Edelman, I. “Participation and service
integration in community-based initiatives”. Journal of Community Practice. 9(1):
Ezell, M; Patti, R.J. “State human service agencies: structure
and organization”. Social Service Review. 64(1): 22-45,
A.A. “Applications of boundary theory to the concept of service integration in the human service”.
Administration in Social Work. 21 (3/4): 31-65, 1997.
Hassett, S; Austin, M.J. “Service
integration: something old and something new”. Administration in
Social Work. 21 (3/4): 9-29, 1997.
Horwath, J; Morrison T. “Collaboration,
integration and change in children's services: critical issues and key ingredients”. Child Abuse
and Neglect. 31(1): 55-69, Jan 2007.
Katz, A.J. “Problems inherent in multi-service delivery units”.
Journal of Sociology and Social Welfare. 5(5): 644-61, 1978.
O’Looney, J. “Marking
progress toward service integration: learning to use evaluation to overcome barrier”.
Administration in Social Work. 21(3/4): 31-65, 1997.
Perlmutter, F.D.; Richan, W.C.; Weirich, T.W. “Services
integration and transferability: implications of the united services agency demonstration project”.
Administration in Social Work. 3(1): 17-31, 1979.
Poindexter, C. “Management successes and struggles
for AIDS service organizations”. Administration in Social Work. 31(3): 5-28, 2007.
Reitan, T.C. “Theories
of interorganizational relations in the human services”. Social Services Review.
72(3): 285-309, Sept. 1998.
Ryan, J; Marsh, J; Testa, M; Louderman, R. “Integrating substance abuse treatment
and child welfare services: findings from the Illinois Alcohol and Other Drug Abuse Waiver Demonstration”.
Social Work Research. 30(2).
Waldfogel, J. “The new wave of service integration”. Social Service Review.
71(3): 463-484, Sept. 1997.
Weinreb, L; Nicholson, J; Williams, V; Anthes, F. “Integrating behavioral health
services for homeless mothers and children in primary care. American Journal of Orthopsychiatry.
77(1): 142-152, Jan 2007.
Williams, C.J. 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. Rutgers, Ph.D., October 1981.