Editor's Note: Delivering and managing health and human services has never been more complex than it is today. Regulators and policy-makers are continually raising the bar with regard to service levels and reporting. Clients are faced with more complex problems, greater needs and higher expectations. Service providers are envisioning new services and innovative ways of delivering them. With all of this, we are faced with a constrained funding environment.
The good news is that information and communication technologies are available to support the planning, provision and management of health and human services.
Prior to the Great Depression, most of those in need received what we now think of as human services from families or charities. In the 1930s, massive government programs were created when families and charities could no longer cope with the demands. In the mid-1960s, the number and complexity of government programs grew dramatically as part of the "war on poverty." The growth of these programs was slowed in the 1980s, and more flexibility was shifted to lower levels of government through block grants and greater flexibility in rule-setting. Today's expectation is that government support should be temporary and designed to prepare individuals and families for self-sufficiency.
The New Service Delivery Environment
Developing self-sufficiency is far more complex than sending a check every month. Government and community services must be aligned with an individual's supports, skills, capabilities and needs. These needs are complex and diverse, including such issues as drug treatment, transportation, mental health services, college courses, family counseling and elder support. To add to the complexity, these services can be delivered by multiple programs within an agency, multiple agencies, different levels of government, private-sector organizations and volunteer community groups.
With greater client mobility and higher client expectations, there is a growing need to expand the delivery of government services. This can be done through a wide variety of channels, including government office visits, home visits, the workplace, the telephone, the Internet, private-sector service providers and health-care venues. In this new delivery environment, services will be accessed by the client through the channel most suited to their particular need at that specific time.
To manage this, governments have implemented a variety of models, including "e-government," "one-window" and "no wrong door." These models require us to build new ways to address client interactions based on their frequency and level of complexity. For example, agencies can use a combination of technical supports (algorithms built into software) and human supports (case manager input) to perform "triage" on each case, determining what types and level of programs and services are ideal for the client's needs. Case managers need tools to supplement their knowledge and networks to identify services or to refer clients to relevant providers.
The job of the front-line worker will continue to undergo fundamental changes. This is in part due to more complex reporting requirements and increasing demands for service. It is also due to the fact that, because the technology is available, the job can and must change. And it's not just front-line workers who are facing change; case managers are overseeing a wider range of services and carrying an increasing caseload.
The pressure to drive down costs and drive up service levels requires workers to focus on matters that require personal attention and professional judgment. This leads to a need for more self-service and highlights the need for all service providers, funders and governments to collaborate broadly to integrate planning and service delivery.
In many programs, there is a growing need to increase client participation to enhance self-sufficiency and avoid or reduce the future need for services. …