Abstract
States are pursuing service integration that differs substantively and strategically from the first wave of service integration in the 1970s. This article describes the new approach, using Maryland's Systems Reform Initiative as an example, and identifies the ways in which it differs from the original wave. The most important substantive difference is that, in contrast to the first wave, which emphasized administrative reforms, these new state initiatives include casework, governance, and financing reforms as well. There are also differences in strategy. The early wave favored top-down initiatives, combined with limited bottom-up activities such as pilot projects. The new wave, contrary to previous efforts, uses a "bootstrapping" approach, in which reform proceeds incrementally, local participants learn by doing, and the state learns by monitoring.
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