Customer Viewpoints

Integrated Services System 2005 Synthesis

In this activity, six groups explored integrated services from the perspective of a particular customer family. Each group had a completely different, unique assignment. A seventh group explored governance models and an eight group worked on vision. These assignments and responses are captured below: Latina | Vietnamese Refugee | East African Man | Caucasian Woman | Bosnian Family | Samoan Mother | Governance Models | Vision

See Team List

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Team 1: 25-year-old Latina

Team 1 Woody Ahn Katie Seitz Melanie Gilbert Sibelle Nguyen David Schraer Terry Stewart

It is 2005. You are Maria, a 25-year-old Latina, a recent immigrant and single mom with three children, ages 1, 4, and 6. You have limited English skills and are a recent victim of domestic violence. The family is currently homeless. You are nervous because you are not a citizen.

Describe the services that you and your family receive from the integrated services system.

What is your experience of getting your needs met by the integrated services system? We hoped that all services in the one-stop location would create trust among the providers and result in the customer's trust in the providers. Maria would become comfortable with the faces of providers because she sees the same people all the time. Whatever door she first walks through, she will be comfortable or find someone who makes her comfortable.

What services do you receive? Initially, the multi-services center would provide interim shelter, housing, medical treatment if necessary for Maria, medical care for the children, cash assistance, food, and clothing. She would also be provided with domestic violence counseling, possibly mental health assistance. They would help her learn the bus routes, help with child care, and provide translation services.

Later, the center would help her get ESL services, which also includes job searching; immigration services to educate her about her rights; and provide information about schools for the children and enrolling the 6-year old in preschool or kindergarten.

Where do you receive services? Many services would be co-located in one place; the others would be readily available within the community.

What are the outcomes? How is your family better off because of the integrated services approach? We hope she is eventually self-sufficient, has a positive outlook on her future, is informed on relevant issues which will help her feel part of the community, is less isolated, is employed, and has been empowered to get information and do things on her own. Her children are being educated and her family is stabilized.

What do you like best about the services you receive? Everything was together in a one-stop shop. The providers were knowledgeable about other services and gave her good references to another “right door.” The providers followed up with one another to be sure the family didn't fall through the cracks. People were friendly and culturally sensitive; providers educated the family and empowered them for self-sufficiency

How is your experience today different from the way it was before services were integrated? People now have frustration about going to many places for service. They lack time but may need to spend the day on a bus to access a couple of services. There is a lack of communication among providers; customers are often told to go to a place that turns out to be “the wrong place.” We need better interagency communication where each provider knows the others, resulting in fewer wrong doors; culturally competent providers, aware and sensitive, who can link to appropriate programs; and real partnerships across agencies yielding more support to families.

Team 2 David Cotlove Joseph Connor Bob Giloth Mabel Magalei Lee Lim Kathy Strand

Team 2: Vietnamese Refugee

It is 2005. You are a Vietnamese man with a wife and son arrived in America in 1992 via the Refugee Program. CPS has recently removed your 7-year-old son from this family because of bruises on his back noticed at school. The father (you) claim it occurred as a result of “coining”, a form of medical intervention used in Viet Nam. You need assistance.

Initially, we rejected the assignment because we believe it couldn't happen. Michael asked us then to show through our model how it couldn't happen and then to show how the system could have failed and allowed it to happen.

Describe the services that you and your family receive from the integrated services system. This is an evolving model. The date is 2008. This is an independently-funded model based upon using natural resources that strengthen and support family. We define “natural resources” as community-based help provided by neighbors, family, volunteers, and friends. These resources naturally occur in the community and don't have to be brought in from an agency. The drive is to maximize natural resources and to minimize secondary (agency) resources. There is also drive to minimize the need for DSHS services and for DSHS to be in a preventive mode.

Where do you receive services? This model is centered on school and community relations. There is a “point person” in each of the community's six to ten schools. This person is connected with the Safeway store and Hope VI integrated services. The school is a part of the community—it will have been accomplished by 2008. For a parent, walking into a school is like walking into the neighborhood, not just being called in around a problem. This impacts the success of the child and the strength of the community. The school's point person has knowledge of all of the other resources to make a quick response to someone with a question.

What services do you receive? The father turns to the school for help because he knows he can do so. He has been educated about this. It would trigger a communication. The could be an interpreter provided, with linguistic knowledge and cultural knowledge and there also could be services back to family to understand what is happening to them. Referral has to happen quickly to prevent agony to the individual. The problem would be sorted out and resolved. This would never have been a CPS referral. CPS workers would be in Safeway and also in schools.

It could fail if it never got to someone who was familiar with integrated services or if any of the participants weren't knowledgeable about the available services. The third way is if the person waited too long to ask for assistance.

If it DOES generate a cps REFERRAL, they get culturally integrated services in right away and avoid removing the child.

Team 3: 37-years-old East African Man

Team 3 Delia Carmen Vanessa Maanao Dave Okimoto Kelly Reid Bob Watrus

It is 2005. You are an East African man, 37 years old, raising 4 children. You need employment and childcare. You have primarily worked as a farmer in a rural area in Africa and have basically no education. However, you refuse to be seen by an employment worker that assisted another family from an ethnic tribal group who has been your family's enemy for generations.

Describe the services that you and your family receive from the integrated services system.

We took an experiential approach to walk through this in his shoes. First, what would be the keys to success? There are themes: community leadership development, building on the natural support system of friends and faith organizations, no wrong doors, information shared across systems, blended funding, common governance, and focus on building assets.

Instead of going to the multi-service center, “Mr. T” goes to his east African neighbor, who connects him with the local faith organization that he's involved in where there are other Somali families. The neighbor connects him to a point person in the church, a volunteer or staff person. There are some services and supports available at the church — e.g. play groups and family relationships. The point person talks informally about how he can help, builds a relationship, and eventually offers to set up an appointment with a bicultural, bilingual person from Somalia who works as a case manager for the family resource center. Mr. T chooses to meet that person at his home, and the church point person also attends. The case manager does intake, determines primary needs, connects him with services for his immediate needs, and also describes more of what is available in the community. This group can provide long-term support because they are sharing information.

Mr. T. can access the services that he needs, in his language, and he can choose what he wants and where he wants to go. He has a support network who can help him solve problems. He can provide direct feedback to the governance structure through representatives of the Somali community who are actively seeking feedback.

Team 4: 43-year-old Caucasian Woman

Team 4 Merguito Anjo Robin Chesgreen Rebekkah Goldsmith Greta Lent Marcy Maurer Wendy Watanabe

It is 2005. You are a 43-year-old Caucasian woman who has been on welfare for more than 15 years needs to find work. You never finished high school and have a very limited work history. You have been very depressed. Your 15-year-old son, a special education student on probation is out of control and you don't know what to do. You think your son may be in a gang.

Describe the services that you and your family receive from the integrated services system. Susan is called into school regarding her son being on probation. In this system, the principal asks her to talk to Marcia, the counselor. Marcia does a focused family assessment to learn what's going on in the family related to the son's problems. Susan tells her the whole story and reports that she does not know what to do.

Marcia talks about services available and how to access them. Would you like to continue with me to talk about what kinds of things we can do to help? Or I can call in a group of people to work with you as a Team?

Susan decides she would like to have some help in these areas, which determine Team membership: Marcia is on the Team for the son's needs, there is a case manager from DSHS, someone from employment security, a mental health worker, specialized help in juvenile rehabilitation, and the community college [Susan wants to finish her high school degree and get continuing education].

What is your experience of getting your needs met by the integrated services system? Susan sits down with her Team for a consultation. The goal of the meeting is that by the end she will have a plan for next steps, both short-term and long-term, and she will have lead contacts with whom she will follow up.

Susan selects counseling for depression, juvenile rehab for her son in, and to finish her GED. There is still a lead person — any person from the Team may end up being the primary contact. This is the client's choice.

What do you like best about the services you receive? Initial point of access comes from anywhere — agency, neighbor. One person ultimately becomes accountable. It's a client co-designed process. She built her plan and she shared accountability. There is a Team approach, it is family focused, it coordinates government and nonprofit support, the support Team represents client-determined need, and she now knows how to access the system.

What are the outcomes? How is your family better off because of the integrated services approach? Be specific. Susan has a concrete plan, she knows what to do, and she has a single person who coaches her. Ultimately she becomes a writer and wins the Nobel Prize after a learning disorder is diagnosed. She improves her relationship with her son, treats her depression, and helps him stay out of trouble because she is more capable. She is confident and happy.

Team 5: Bosnian Family

Team 5 John Chadwick Ron Falberg Gail Hayes Ken Miller Richard Nichols Tom Slattery

It is 2005. You are a Bosnian family including a 14-year-old daughter and 10-year-old son and you want to improve your lives. Dad is working but wants a better job. Mom's English is very limited and wants to be a teacher. Dad's job doesn't provide health care and everyone in the family needs dental work.

In 2005, we have “The System” of integrated services.

Describe the services that you and your family receive from the integrated services system. What is your experience of getting your needs met by the integrated services system? What services do you receive? Where do you receive services?

We see many different ways and methodologies to approach this. Hopefully, there is no wrong door. There are various places the family can go—a private clinic, school, CDC, dentist, community college, school, DSHS etc.

We think the school would be the first to identify needs in this family. The school has a tie to DSHS. The mother might be involved with the daughter in school. From there, the family would be directed to a private clinic, where they could identify services, language needs, educational needs, and to help in determining and assessing eligibility. From there, it further developed that mom could probably be served well by the CDC. As a continuation, she is proceeding on to community college level. “No wrong door” results in a positive advancement for the whole family.

What are the outcomes?

What do you like best about the services you receive?

How is your family better off because of the integrated services approach? Be specific. There are five specific positive outcomes:

1. success in school
2. healthier kids
3. Mom is increasing English proficiency
4. Father later goes to CDC as well
5. Mom is becoming job-ready and enhancing educational background

How is your experience today different from the way it was before services were integrated? The problems could be identified early on. Services are more comprehensive, paper work is portable, and there is interconnectivity between perhaps all of the services. In two years we are moving more towards a preventive rather than an interventive pattern and services are delivered faster. There is more of a common intake assessment and a focus on the whole family.

Team 6: Samoan Mother

Team 6 Vicki Asakura Theresa Fujiwara Ngy Hul Len Kruszecki Peter Moure

It is 2005. You are a Samoan mother of 5 is seeking help around her children's educational needs. The kids' ages are 3,7,8,11, and 15. Your daughter is pregnant and no longer attending school. The younger kids are frequently absent from school because of a reoccurring problem with lice. The school has referred this family to a service agency for help. The worker notices that mom's breath smelled of alcohol and that there were several black and blue marks up and down her arm.

Our system is called The White Center Integrated Service Center.

Describe the services that you and your family receive from the integrated services system. There are no wrong doors, but not every door can provide for every language and culture. Therefore, we use a common intake system with all languages and cultures represented. The appropriate person would come to that open door, wherever it is, and bring all the integrated services with them to the home, the local center, whatever. There is a centralized screening Team who go out to the community.

This point person would go to the school and do a strength-based assessment. Who is the family comfortable with and with whom are they connected? For example, they may be comfortable with a church. This point person also becomes the “glue” — the point of contact with the family.

Within integrated services, we have hubs of co-located partners, and a core Team of multi-disciplinary people. Then there are specific agencies that can provide certain services — e.g. the school nurse and family health, taught them how to rid the lice.

What are the outcomes? We worked with the family holistically — there were issues around drug, alcohol, and possible domestic violence. The family was linked up with Planned Parenthood and other ancillary services. The services helped to keep the pregnant daughter in school.

Team 7: Governance Models

Team 7 James Fong Roxanne Hood-Lyons Hava Jazvin Bonnie Liebel Tammy Pitre Bob Shimabukuro

Please answer the following questions:

There is no way we can know how the governance structure would evolve. We came to some questions — if we answered them, we would have a better idea of next steps. So, what are the existing groups, what decisions are they making or empowered by — how could others become involved — what is the source of the authorization? There is an exercise of “responsibility charting” that could be useful here. Who approves — who needs to be consulted, who needs to be informed? Different people have totally different understandings of that. We don't know enough to create a governance structure.

What commitments are required to make the system most effective? We talked about funding streams and a group that can manage funding and make it transparent to the rest of the group — the money blenders. Another group includes community members who use the services, family advocates, (conduits between community members and social services), and the institutional service providers. All three voices need to be present in the conversation. Lots of the end users and advocates don't want to know all of the behind-the-scenes action. Now there are partners group and deputies — we don't know the extent of their authority

What is the decision-making process? We would request transparency and clarity on decision-making? For example, who decided that the Family Services Center is a “thing” that will happen? Do we know yet that it is? There is a group who seems to have authority for that, but where does it derive from?

How is feedback provided / gathered? How is accountability ensured?

What is the role of the community in the governance process? There may be some tension between Hope VI and Safeway about what's going on; that may be related to a lack of clarity about who is responsible for what. Many decisions are embedded in that including cost allocation — what is the process by which this will be resolved? Legal issues and funding policies are not the real issues. The real issues have to do with turf and domain. Integrated services work only where there is enough motivation and willingness to work hard to build across the silos. That's why it would be easier in San Mateo (county based) than in Seattle where there are city, county, and state jurisdictions.

We are missing the larger community engagement piece. There is not enough broad knowledge of the whole system or how it might fit together. There has to be more direct communication between “users” and leadership.

The common piece where everyone would agree would be about the values. In this case, we are all headed towards “FAMILY SUPPORT.”

Team 8: VISION

Team 8 Anthony Anderson Liz Dunbar Jayne Kauzloric Teresa Montana Dan Owens Veronica Solis

Using the prepared vision statement and the work done earlier today, create a new vision statement that incorporates the best thinking of all of them.

We started to push back on this assignment when we looked at the work already created. We said, 'this is perfect, let's embrace it!' But we realize that perfection is mutable. There is room for come adaptation.

The vision: is to support White Center and Boulevard Park families and individuals in their efforts to improve the quality of their life.

The key points of the vision are to create a neighborhood-based family resource center