Human Service Agencies Research Articles

Learning from the Field: Exploring Service Integration in Public Human Service Organizations

ABSTRACT There is growing interest in finding ways to improve the integration of human service programs in order to improve client services. This unique learning case provides the following perspectives: the historical context of different efforts to promote service integration in the U.S. over many decades; two works-in-progress to reflect the trial-and-error approach to fostering greater service integration; the experiences of a suburban-rural county human service agency seeking to promote bottom-up integration through integrated case management across various public organizations; and the experiences of a different suburban-rural county demonstrating a top-down approach to reducing the silos across multiple divisions in an integrated health and human service organization. The case concludes with multiple discussion questions.

Family homelessness, subsequent CWS involvement, and implications for targeting housing interventions to CWS-involved families

BackgroundHomelessness is a risk factor for family involvement with child welfare services (CWS). Housing interventions are promising—but reasons for this are not well understood, and housing resources could be better targeted to families at risk of increased CWS involvement. ObjectiveWe sought to better understand the relationship between homelessness and CWS involvement and examine whether homeless shelter data could combine with CWS data to enhance intervention targeting. Participants and settingFor 4 years, we followed 2063 families investigated by the San Francisco Human Services Agency in 2011. MethodsMatching CWS data to homeless shelter data, we fit Cox models to examine the relationship between shelter use and subsequent CWS outcomes and produced ROC curves to judge model accuracy with and without shelter information. ResultsAbsent CWS covariates (family demographics, CWS history, and family safety and risk), past shelter entry predicted repeat maltreatment referral (HR = 1.92, p < .001), in-home case opening (HR = 1.51, p < .05), and child removal (HR = 1.95, p < .01), but not child reunification. With CWS covariates, past shelter use no longer predicted case opening and child removal, but still predicted referral (HR = 1.58, p < .01). Shelter data did not contribute to models’ predictive accuracy. ConclusionsWe find mixed evidence that shelter use independently leads to CWS involvement. Housing interventions might help by addressing present housing problems and family experiences correlated with past shelter use. However, we find no evidence that data matches with shelter systems could enhance targeting.

INNOVATION IN A CAPSTONE COURSE IN YOUTH WORK

Capstone courses often focus on applied learning, typically practicum experiences such as internships. However, students do not always benefit as much as they could from their internships because teaching and learning resources are not used optimally. This paper explores the use of project-based learning in a capstone course of the Graduate Diploma in Youth Work program at Concordia University that includes an in-class seminar and an internship in a human services agency. Using the principles of context authenticity and cognitive apprenticeship from the Authentic Situated Learning and Teaching (ASLT) framework, we examine the experiences of two cohorts of interns (24 students in all). An analysis of their final papers and participation in a focus group, as well as the results of the university’s course evaluation, suggests that the ASLT framework contributes to the transfer of learning in a professional setting. Furthermore, the use of the psychoeducative model to structure active pedagogies in a youth work capstone course provides a means for planning therapeutic activities and organizing intervention programs that help develop competencies to work in diverse settings.

Job strain in nonprofit human service agencies: Job demands and job control's additive effects, and goal‐related feedback's mediating role

AbstractFew quantitative studies in the nonprofit literature have examined job demands' strain‐inducing impact. The classic demand‐control (DC) model predicts a positive main effect for job demands and a negative main effect for job control on job strain, respectively. However, four decades of DC model studies have uncovered modest support for this additive model. As a means of addressing both issues, the present study tested a recently introduced modified additive model using 621 employees from two different types of nonprofit human service agencies located in the city of New York. Two mediational analyses, structural equation modelling and bootstrapping, corroborated goal‐related feedback's intervening role on the control‐strain relationship. Findings not only replicate and extend prior research, but also make a unique contribution to the nonprofit literature. Implications for the stress management of nonprofit human service employees, as well as recommendations for the DC model literature are also discussed.

The Perils of Privatization: Bringing the Business Model into Human Services.

During the last three decades in both the United States and Europe, neoliberal policies, especially privatization, have restructured services in ways that dramatically affect the capacity of human services workers and agencies to serve all clients. Privatization means not only transforming public programs such as Social Security, but also managerialism-the incorporation of business principles, methods, and goals into public and nonprofit human services organizations. Few researchers have looked at the impact of market-based managerialism (focused on productivity, accountability, efficiency, and standardization) on social work's mission and the effectiveness of human services workers and organizations. Using an anonymous survey of 3,000 New York City human services workers, authors examined the impact of managerialist practices including performance measures, quantifiable short-term outcomes, and routinized practices on frontline workers and service provision. A troubling trend emerged. Workers in agencies with a high commitment to managerialism found it considerably more difficult to adhere to social work's mission and fundamental values. This conflict between the "logic of the market" and the "logic of social work" subsided dramatically in agencies with a low commitment to managerialism, indicating that even in today's competitive environment, agencies can protect the social work mission.

Skills for Collaboration: Training Graduate Students in Using Evidence to Evaluate a Homelessness Program

ABSTRACT This article describes how a university and public child welfare agency partnership and a federal demonstration project trained MSW and PhD social welfare students in homelessness intervention research using a continuous quality improvement approach. Over a period of 5 years, the Cal-Child Welfare Leadership Training model between University of California, Berkeley’s School of Social Welfare and San Francisco’s Human Services Agency sought to train graduate students how to find, generate, and use evidence for child welfare decision making. Simultaneously and independently, the partnership designed and implemented a 5-year randomized controlled trial testing the effectiveness of permanent supportive housing for homeless families entering the child welfare system, called Families Moving Forward. We took advantage of the congruity of these two efforts by bringing student interns directly into the ongoing implementation and evaluation of Families Moving Forward, exposing them to implementation challenges that contextualize and moderate expectations about how a complex program for complex families should lead to improved outcomes. The aim was to endow students with the knowledge, skills, and discipline necessary to help make complex interventions work by fostering cross-system collaboration. We propose ways this teaching model can be scaled and installed elsewhere.

The Impact of Ongoing Staff Development on the Health and Safety of People with Intellectual and Developmental Disabilities

Direct support professionals (DSPs) provide people with intellectual and developmental disabilities (IDD) with individualized, personal assistance in a wide variety of settings. There is currently a very high turnover for DSPs, due in part to a lack of training for DSPs. The aim of this study is to explore how ongoing staff development impacts the health and safety of people with IDD. Our research question was: how does ongoing staff development, geographic location, and agency size impact the health and safety of people with IDD? To explore this research question, we analyzed data from 74 human service organizations which supported 8264 people with IDD, particularly examining the relationship between ongoing staff development from the Basic Assurances® and health and safety data regarding abuse and neglect, emergency room visits, and injuries. Our findings revealed that by simply offering ongoing staff development, human service agencies can potentially radically improve their service provision, and by extension the health, safety, and human security of the people with IDD they support. Ongoing staff development is an investment not only in the quality of services and supports DSPs provide to people with IDD, but also DSPs themselves.

The Partner Relay Communication Network: Sharing Information During Emergencies with Limited English Proficient Populations.

Sharing information with people with limited English proficiency is a universal challenge. The County of San Diego has a diverse population and, as a result, language and access barriers present serious risks when communicating disaster and public health emergency information. In support of the "Live Well San Diego" vision of a county that is healthy, safe, and thriving, the County of San Diego Office of Emergency Services and Health and Human Services Agency, Public Health Services, worked to design a community-based program to address this critical issue. Program development included a literature review of existing strategies as well as gathering community input. Documented promising practices included: (1) community engagement during planning, design, and implementation of communication plans to create buy-in and a sense of ownership; (2) dissemination of translated messages; and (3) communication through culturally appropriate and trusted channels, including individuals, community groups, and organizations. Using a systematic approach, the program engaged leaders and community representatives of the top 6 languages spoken in San Diego (following English)-Spanish, Tagalog, Chinese, Arabic, Korean, and Vietnamese-and 2 recently arrived refugee groups, Karen and Somali. Community input was gathered through focus groups, feedback sessions, training sessions, and drills. The community's recommendations mirrored the existing promising practices, and a program strategy was adopted.

Optimizing Screening for HIV.

BackgroundThe HIV epidemic is unevenly distributed throughout the United States, even within neighborhoods. This study evaluated how effectively current testing approaches reached persons at risk for HIV infection across San Diego (SD) County, California.MethodsHIV case and testing data, sexually transmitted infection (STI) data, and sociodemographic data for SD County were collected from the SD Health and Human Services Agency and the “Early Test” community-based HIV screening program between 1998 and 2016. Relationships between HIV diagnoses, HIV prevalence, and STI diagnoses with screening at the ZIP code level were evaluated.ResultsOverall, 379 074 HIV tests were performed. The numbers of HIV tests performed on persons residing in a ZIP code or region overall strongly correlated with prevalent HIV cases (R2 = .714), new HIV diagnoses (R2 = .798), and STI diagnoses (R2 = .768 [chlamydia], .836 [gonorrhea], .655 [syphilis]) in those regions. ZIP codes with the highest HIV prevalence had the highest number of tests per resident and fewest number of tests per diagnosis. Even though most screening tests occurred at fixed venues located in high-prevalence areas, screening of residents from lower-prevalence areas was mostly proportional to the prevalence of HIV and rates of new HIV and STI diagnoses in those locales.ConclusionsThis study supported the ability of a small number of standalone testing centers to reach at-risk populations dispersed across SD County. These methods can also be used to highlight geographic areas or demographic segments that may benefit from more intensive screening.

Managing Disaster Preparation amid Conflicts of Interest: A Teaching/Learning Case Study

ABSTRACTThis teaching case explores challenges faced by a nonprofit Area Age Agency on Aging (AAA) director struggling to extend traditional elder service and support functions (case and care management, nutrition, transportation, etc.) to inlude disaster preparedness. The director is torn by the desire to promote diaster safety by supporting the Long Term Care Ombudsman watchdog program that is creating political turmoil and may someday advocate against the actions of the AAA itself. Three themes emerge: (1) addressing challenges in implementing mandates within nonprofit organizations as well as balancing advocacy and diret service provision roles, (2) providing effective leadership in managing professional autonomy, boundaries, and COIs within and across human service agencies, and (3) training and collaborating with diverse organizations on disaster preparedness for older people across LTC settings. Immediately following this case, is an analysis of lessons learned and discusion questions designed to promote critical thinking and reflection.

Does Contingency Work in Human Service Agencies Compromise Practice and Practice Ethics?: An Exploratory Study

ABSTRACTThe use of contingency workers has increased in the human service sector though the consequences of this labour arrangement have not been examined. This article reports findings from an exploratory study in which 15 human service workers employed on a contingency basis were interviewed regarding their choices and the consequences of their jobs. Two broad research questions guide discussion and analysis: (1) how do current contingent workers describe or assess their employment situations, and (2) given this information, how might contingency status impact practice ethics. Results suggest that because of the precarious nature of contingency work, practice ethics are compromised. Respondents reported that they do not have access to regular supervision or are not attached to their co-workers or agencies, which means that they are not able to readily consult with others when ethical challenges arise. Discussion focuses on the broader implications that contingency arrangements have not just for ethical decision-making, but for the development of the workers, the agencies, and the human service sector.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.

Estimating the Effect of a National Pharmacy-Led Influenza Vaccination Voucher Program on Morbidity, Mortality, and Costs.

Influenza (also known as "flu") is estimated to cause between 12,000 and 79,000 deaths annually. Vaccinations are beneficial in preventing influenza cases and reducing the likelihood of severe outcomes. Unfortunately, vaccination coverage is low among uninsured populations. Removing the cost barrier can help increase vaccination coverage in this group, averting flu cases and related morbidity and costs. To model the potential effect of providing no-cost flu vaccinations to uninsured individuals on influenza-related morbidity, mortality, and costs. In collaboration with the Department of Health and Human Services and local agencies, Walgreens pharmacies provided free flu vaccinations through a nationwide voucher distribution program. We calculated the redemption rate, potentially averted cases, and estimated cost savings for the 2015-2016 and 2016-2017 flu seasons. Using incidence and vaccine effectiveness estimates from the Centers for Disease Control and Prevention, we calculated the rate of influenza in the general population and the estimated cases averted based on the number of redeemed vouchers. We applied patient age along with parameters from published studies to estimate averted ambulatory care visits, hospitalizations, mortality, productively losses, and overall related costs. During the 2015-2016 flu season, the pharmacy chain distributed 600,000 vouchers with a redemption rate of 52.3%, resulting in 314,033 flu vaccinations. Improvements were subsequently made to the distribution process to increase utilization rates. There were 400,000 vouchers distributed during the 2016-2017 season with a higher redemption rate of 87.2%, resulting in 348,924 flu vaccinations. The estimated number of potentially averted cases was higher during the 2016-2017 season (13,347) than the 2015-2016 season (11,537) due to a higher redemption rate and increased flu activity. Taken together, we estimated that 8,621 ambulatory care visits, 314 hospitalizations, and 15 deaths were averted due to the flu voucher program. Averted health care costs totaled $937,494 in ambulatory care visits and $3,510,055 in hospitalizations. Averted productivity losses ranged from $4,473,509 to $14,613,502. This study demonstrates the effectiveness of a pharmacy-led partnership with local community-based organizations to promote flu vaccinations among uninsured individuals. Our model found that a no-cost flu voucher program has the potential to reduce influenza-related morbidity, mortality, and costs. This study was funded by Walgreen Co. All authors are employees of Walgreen Co. and affiliated with Walgreens Center for Health and Wellbeing Research. Findings from this study were presented as a podium presentation at the Academy of Managed Care Pharmacy Nexus 2018; October 22-25, 2018; Orlando, FL.

Systematic overview of Freedom of Information Act requests to the Department of Health and Human Services from 2008 to 2017

BackgroundThe Freedom of Information Act (FOIA) provides access to unreleased government records that can be used to enhance the transparency and integrity of biomedical research. We characterized FOIA requests to Department of Health and Human Services (HHS) agencies, including request outcomes, processing times, backlogs, and costs.MethodsUsing HHS FOIA annual reports, we extracted data on the number of FOIA requests received and processed by HHS agencies between 2008 and 2017, as well as request outcomes. Processing times were reported in three time increments, < 1–20, 21–60, or 61+ days, and trends in backlog status were also described. Information about costs and fees collected were aggregated.ResultsBetween 2008 and 2017, 69.6% of 530,094 HHS FOIA requests were received by the Centers for Medicare and Medicaid Services (CMS), 18.9% by the Food and Drug Administration (FDA), and 11.6% by all other HHS agencies. During this period, CMS processed 374,728 requests, FDA 114,938, and other HHS agencies 61,890. CMS and FDA reduced backlogged requests by 9396 (89.7%) and 4289 (65.3%), respectively, leaving backlogs of 1081 and 2279 requests at the end of 2017. CMS fully or partially granted 60.3% of requests whereas FDA fully or partially granted 72.4%. Of all requests to CMS, 82.0% were considered simple and 18.0% complex; 82.2% of simple requests and 54.9% of complex requests were processed in 20 days, and 5.6% and 29.9% were processed in 61+ days. In contrast, 60.2% of requests to FDA were considered simple and 39.8% complex; 28.8% of simple requests and 9.0% of complex requests were processed in 20 days, and 58.3% and 81.5% were processed in 61+ days. The costs to HHS associated with FOIA requests totaled $446.4 million ($809 per processed request), increasing from $28.1 million ($423 per request) in 2008 to $53.3 million ($1544 per request) in 2017. In total, HHS collected $8.5 million in fees (1.9% of total costs).ConclusionsFOIA is frequently used to obtain information about HHS and its agencies. With growing costs, minimal fees collected, and lengthy processing times, HHS agencies’ FOIA programs might be made more efficient through greater proactive record disclosure.

Constructing Accountability: The Development and Delegation of Outcome Evaluation in American Social Work

AbstractA common explanation for the rise in outcome evaluation among American human service agencies is the concomitant spread of performance-based funding in the late twentieth century. Although ...

PARENTING ALL OVER AGAIN : HISPANIC “ABUELITAS” RAISING GRANDCHILDREN IN THE CONTEXT OF SUBSTANCE ABUSE DISORDERS

Around 7 million grandparents in the U.S live with grandchildren under 18 and 39% have primary caregiving responsibilities. In Texas, more than 313,499 children under age 18 live with a grandparent who is responsible for them. Hispanic grandparents are disproportionately more likely to care for grandchildren compared to non-Hispanic whites. In San Antonio, Texas, 36.6 % of grandparents are the primary caregivers for their grandchildren. Parental substance abuse disorders have been identified as one of the causes prompting child removal from parental custody. To understand the experience of custodial Hispanic grandmothers raising their grandchildren, three focus groups were conducted in English and Spanish by three bilingual investigators. Twenty-three grandmothers, mean age 60, caring for an average of 3.2 children, 2 months to 17 years of age participated in the focus groups. The narratives were transcribed and analyzed in the source language. The following overarching themes were identified: Family is family, parenting all over again, this is a struggle but a blessing, what did I do wrong? , fear of losing the children to foster care, I do not trust anybody with my children, financial and legal challenges, role captivity, aging as a limitation, and hope for the future. The findings from the study contribute to the body of knowledge necessary to foster urgent policy changes aimed at supporting these grandparents who feel unjustly treated by human services agencies and the legal system. Programs to support custodial Hispanic grandmothers need to be linguistically congruent and culturally competent.

Implementation of the US Department of Health and Human Services Zika Specimen Repository and Its Effect on Zika Diagnostic Test Development, 2016.

This study describes the efforts and outcomes associated with the establishment of a clinical sample repository during the 2016 Zika virus epidemic. To overcome the challenge of limited access to clinical samples to support diagnostic test development, multiple US Department of Health and Human Services (HHS) agencies formed a partnership to create the HHS Zika Specimen Repository. In 2016-2017, the Biomedical Advanced Research and Development Authority and the Centers for Disease Control and Prevention collected patient specimens (4420 convalescent sera aliquots from 100 donors and 7171 plasma aliquots from 239 donors), confirmed Zika virus test results, assembled 1 panel for molecular testing (n = 25 sets) and 7 panels for serologic testing (n = 92), and distributed the panels to test developers. We manufactured 8 test panels and distributed 74 sets of panels to 32 commercial companies, public health partners, and research institutions. Manufacturers used these panels to generate data that supported 14 US Food and Drug Administration (FDA) emergency use authorizations and 1 FDA approval. To develop a repository that can respond immediately to future disease outbreaks, we recommend that organizations pre-position procedures, resources, and partnerships to optimize each partner's contribution.

1618. Public Health at the United States/Mexico Border: Evaluation of the County of San Diego Health and Human Services Agency’s Health Screening Assessment of Asylum-Seeking Families at the San Diego Rapid Response Network Shelter

BackgroundMany families arrive at the United States–Mexico border seeking asylum. Jewish Family Service and the San Diego Rapid Response Network operate a shelter in San Diego that provides shelter, food, clothing, legal services and travel coordination for asylum-seeking families. Two local federally qualified health centers provide on-site urgent care.MethodsIn late December 2018, the County of San Diego expanded public health efforts by conducting health screenings of guests upon entry to the shelter with the goal of identifying health issues requiring urgent or emergent evaluation and preventing the spread of communicable disease. University of California San Diego Health physicians contracted by the County of San Diego Health and Human Services Agency (HHSA) nurses and ancillary staff provide daily on-site services to all shelter entrants including: health screening for diseases of public health significance, treatment and/or referral of urgent conditions, and medical clearance for shelter entry or medical isolation as needed. Official tracking of screening outcomes from January 2 to April 24, 2019 were collected using standardized surveys and analyzed for program evaluation and surveillance purposes.ResultsDuring that time a total of 9,124 asylum-seekers were screened, averaging 81 guests daily, identifying: 42 influenza-like illness, 645 lice, 330 scabies, 8 varicella, and 0 hepatitis A cases. Chest radiography for suspected tuberculosis was performed for 29 guests. Only one chest x-ray was abnormal. Sputum specimens for acid-fast stain (n = 3) and nucleic acid testing (n = 2) were all negative and no tuberculosis cases were diagnosed. Emergency department referrals were made for <1% of guests (n = 90) for conditions including pregnancy complications, asthma, dysentery, hemoptysis and fractures. No deaths or outbreaks of communicable disease occurred.ConclusionCoordination among local partner agencies resulted in early identification of communicable and acute health conditions prior to shelter entry allowing evaluation, treatment and off-site isolation, and minimizing stress on the emergency medical services system. This approach provides a successful model for health screening of asylum-seeking families arriving at the United States–Mexico border. Disclosures All authors: No reported disclosures.

State Efforts to Support the Engagement of Nonresident Fathers in the Lives of Their Children

Few states invest in programs to help nonresident fathers engage in the financial and emotional lives of their children. The present study examines 12 exemplary states that promote, fund, and evaluate nonresident fatherhood engagement through an array of state agencies, policies, and fatherhood programs. Our study finds that states with substantial fatherhood initiatives share some common characteristics, including strong leadership from executives of state human service agencies, funding from the Temporary Assistance for Needy Families (TANF) block grant and/or child support, multiagency collaborations for service delivery, and documentation of program benefits and return on investment.

Community college field placement internships: supervisors’ perspectives and recommendations

ABSTRACTCommunity College human services students represent the future social service workforce. The defining feature of their training is 250 h supervised field placement internship. Despite burgeoning research describing best practices for supervision of Bachelors of social work (BSW) and Masters of social work (MSW), there is no research aimed at supervision for community college students, leaving a gap in our understanding of best practices for supporting community college students’ pedagogy and sustaining partnerships with agencies. This exploratory study offers recommendations for best practices supported by our discovery of the benefits, challenges, and strategies involved with offering community college student internships in New York City human services agencies. We analyzed data from semi-structured interviews with 30 field supervisors through qualitative content analysis. Community college students and agencies both benefit substantially from the field placement, however agencies identified significant social and structural challenges specific to working with community college students that require interventions for both field supervisors and students alike. Suggested interventions aimed at improving supervisor training, procedures for focusing goals of supervision sessions, assisting students in meeting their academic and social needs, as well as supporting supervisors’ professional goals to promote best practices are proposed.