Health & Human Services Cooperation

One of the things that became quickly obvious to me as a new legislator was that the county government was tightly "vertically aligned". That is, lines of authority are present within each department, beginning at the top with, for example, the Public Health Director in the Department of Health, and flow down the organizational chart within the department.

The advantage of such a system is that the lines of authority within each department are quite clear, and where the buck stops in each department is obvious. What concerned me was that segments of our population were likely to be receiving services from multiple departments at one time. Where the vertical alignment could fail, it seemed to me, would be in efficient coordination of services when multiple departments were serving the same people. I pushed the concept of "thinking horizontally", or across departments, to see where we might be able to develop efficiencies, reduce duplication of services, etc.

If this sounds rather theoretical, well, maybe it is. I struggled with how to put this into actual operation; most of my time was spent discussing the concept, not making concrete progress in becoming horizontally integrated. But to my rescue came the Department heads in Health and Social Services, who worked together, without my (or any other legislator's) direct involvement, to put into place what had until then just been an idea. I was thrilled to receive the following e-mail from these two department heads recently:

We have recently worked with our staff to analyze the coordination and effectiveness of our case management programs for families with young children. We feel it is important to share the steps we took and the things we learned with both of you.

1. We started the process by meeting with Program Directors to discuss funding streams, regulations, and purposes of our respective services. We were specifically reviewing the services offered by the Health Department's Children with Special Needs service coordination programs and the Department of Social Services' preventive/foster care case management programs. It was clear from the beginning that the purpose of our programs and the expertise of our employees are different. The Health Department service coordinators focus on child developmental and medical disabilities (more long term factors) and the DSS caseworkers focus on health and safety (more immediate household factors).

2. We decided to come up with a list of cases that were served by both Departments to begin our analysis. This resulted in 14 cases being served by both Departments. Five of the 14 were served by the Health Department's Child Find program, which provides only surveillance visits every six months.

3. Next, we had our supervisors set up case conferences with the line staff involved in each of the cases that are served by both Departments. The purpose of these conferences was to explore duplication of efforts, share information, evaluate what coordination efforts were missing or needed, and to establish ideas for future coordination.

4. We learned the following things from these case conferences:

- There is no duplication of the work being done in these very needy families.
- There is a need for more information to be shared by staff working with common families to better align case goals and messages given to families. This includes a need to coordinate with all other service providers working with the families under contract.
- There is a common barrier identified by both Departments that mental health services for young children are not adequately available in our community. Linda Medeiros has been made aware of this and will be assisting us in tracking any referrals that cannot be accommodated with current services.

5. We are implementing the following things as a result of our discussions to better maximize our effectiveness:

- DSS caseworkers will consistently have families sign releases of information for our contract parent educators to be able to speak to Health Department coordinators.
- DSS caseworkers will consistently invite Health Department coordinators to meetings with families to review goals and plans every six months. Health Department coordinators will invite DSS caseworkers to reviews they hold with families in the homes. Attempts will be made to have all service providers involved with a family attend these reviews.
- Workers from both Departments will be expected to keep one another informed of significant case planning changes including case closure.
- DSS caseworkers will be invited by the Health Department to Committee on Preschool Special Education meetings when kids are transitioning from the Early Intervention Program.
- Referrals for young children with mental health needs are going to be made to the Mental Health Clinic so that there is documentation to verify what many perceive to be an unmet need (in the past, many referrals were not made as we knew services were not available).
- The supervisors from DSS and the Health Department are committed to having regular contact with one another and monitoring the communication between staff on cases in common.

I am thrilled with the efforts made by these department heads and their staff. I hope that interdepartmental cooperation becomes the norm.