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Integrated Services
Models
Consideration for Model Selection | The Models | One-Stop Shops | Centralized Services
"Regardless of how difficult the clients might be and how easy it may be to blame them when things do not go well, provider-provider interaction is often the critical and rarely acknowledged factor in many of our service delivery failures." — McMahon and Luther (1998)
Consideration for Model Selection top
Use these considerations as you review each of the following models. The right model may require the most work, yet yield the maximum benefit for your customers, staff, agency and community.
- How do we relate to the family?
- What are our common values, goals and objectives?
- What is our decision making process?
- What is the access, distribution and control of resources?
- How do we relate to one another and address conflict?
- What is our agency and community culture? To what degree must we adjust to incorporate this model effectively? Are we willing and able to change to make this possible?
The Models top
Single-Worker Models | Team Models
Single-Worker Models top
The single worker model combines two or more functions that have traditionally been performed by separate workers. This is sometimes motivated by how related functions are (such as welfare-to-work and employment services), or the isolation of the target population.
The single-worker model requires the worker to adhere to multiple program policies, procedures and negotiations, and requires a greater breadth of knowledge and training.
Advantages of this model include a single point of contact for the customer, increased opportunities for relationship building and knowledge of the customer's competing needs and services.
Team Models top
Multiple models for teams in integrated services exist. One author remarked that this creates professional breath as well as depth. Teams provide a broad range of assessments and services.
Lateral Pass Model
The lateral pass model team generally provides intake and assessment services. The assessments provided may be quite broad; however, services are often limited. The customer may be passed to a specialist when their assessed needs exceed predetermined parameters. The model does not demand team meetings, although they may be used for information sharing. Team decision making is not an issue, as transfer decisions are made by the established assessment and protocol criteria.
The lateral pass model requires the worker to be knowledgeable about assessment tools and processes and the availability of services. A relationship with both customers and workers is needed, along with the ability to transfer relationships with the customer to other workers.
Advantages of this model include a reduced knowledge demand for workers. The model also provides greater access to specialized services for customers.
Consultation Model
The consultation model employs a single contact with the family that is supported by a multidisciplinary team. The larger team provides support, expertise and consultation to the contact worker. The team of consultants is often invisible to the family.
The model requires a high degree of self and other knowledge by the worker. The worker must have the ability to discriminate what issues should be brought to the consultation team and the ability to operationalize their recommendations.
One of the strengths of the consultation approach is the professional depth and breadth that is achieved without compromising the relationship of the customer or worker.
Stable Multidisciplinary Teams
The stable multidisciplinary teams represent professional breadth. The participating disciplines regularly participate in team information sharing. The team composition may be determined by target population characteristics, geographical location or simply those local agencies willing to participate. Decision making may be made by the team or a lead case manager. The family may, or may not, participate in the team meeting, depending on how fully family-focused practice has been embraced.
The model requires a deep commitment on the part of the individuals and their agencies. Teams need time to develop and work together, which can be challenging if workloads are high. Since team composition is stable, the services a family needs may not be participating. Conversely, professionals without a vested interest in the family must continue to attend the meetings. Teams also need clarity about their ability to commit agency resources, and how the agencies interrelate. Finally, teams need training and support.
Some of the advantages of the stable multidisciplinary model spring from its challenges. With a stable team comes the opportunity to develop smoother individual and group relationships. As family needs shift, services may be quickly mobilized if they are part of the team. Since clarity about agency commitment is achieved, formal processes are in place to support the team.
Flexible Multidisciplinary Teams
The composition of flexible multidisciplinary teams varies according to the needs of the family. While contact with one agency (by the family) may have triggered the formation of the team, team composition emerges from the assessment and family request. These teams often include informal service providers such as extended family, friends, neighbors and faith-based associations. While it is possible for these teams to meet without the active participation of families, they rarely do. Many of these teams employ a strength-based approach. Information sharing is liberal. One variable in this approach is decision making. While some use a team-driven approach, others allow for private family time.
The role of the teams when families have greatest decision making is to set parameters, provide services and resources and assist the family to strengthen their plan. Because the team composition varies, it requires structure, preparation and time to conduct its work. The investment in preparation should not be underestimated. Some studies indicate that an initial team meeting can require as much as 40 hours of preparation time. Even selecting a meeting time and place can be more challenging, as there is not a blocked time in schedules. The inclusion of informal supports may mean that meetings are scheduled outside of "normal business hours." These teams require team development, clear communication and a dedication to specificity in the family plans that emerge from the process.
The process is very family-focused. From its inception, a transitional process is created for the family to move from mostly formal to informal supports, with occasional formal supports. The process brings together all of the resources and services that the family may need, but none that they do not need. Flexibility allows team members to enter and leave the process as family needs evolve. The approach provides the maximum family input while utilizing professional resources and services.
One-Stop Shops top
"One-stop shops," as neighborhood services are often dubbed, are physically co-located multidisciplinary professional services. They may employ any or several of the integrated service models. Some "one-stops" are associated with homeless shelters, victim shelters, child development centers or residential treatment services.
At least one strong tie exists between services such as geographical area, target population or desired outcome, and provides the framework and motivation for working together. One-stop shops will incorporate the challenges and advantages of the practice models being utilized.
Distinct advantages to one-stops shops include neighborhood accessibility and visibility, reduced time spent traveling by staff and customers, available space for team meetings and access to other professionals for consultation and communication. The value of frequent communication, both formal and informal, contributes greatly to the success and satisfaction of the model.
Centralized Services top
Centralized services create a connection and access to resources between two or more disciplines. The services are a network of professional service providers who have found a frequent need for access to often-scarce resources. Centralized services are primarily links to information and resources, invisible to the family and not participatory.
The method requires that a coordinating or matching service be devised and implemented. Participating professionals and agencies must be constantly feeding information about customer needs and available resources. A high-level of confidence in the integrity of the information and a match between needs and available services is important.
The centralized services method can be highly efficient in allocating resources and requires modest amounts of time and effort on the part of participants. However, it can help to insure that available services are used.
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