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Boulder County, Colorado: Integrated Service Delivery

By Sam Gill, Indi Dutta-Gupta, and Brendan Roach

This is the seventh in an article series based on the paper "Gaining Ground: A Guide to Facilitating Technology Innovation in Human Services."

Since the creation of a unified Department of Housing and Human Services (HHS), Boulder County, CO has been a testament to the benefits of holistic human services delivery. Through its integrated service delivery system, Boulder County has been able to expand the number of residents receiving services by 140%, focusing on front-end and early intervention measures to prevent more costly services in the future.

Technology has been a key feature of this transition. The Department, as it exists today, was formed after a 2008 merger between the County’s housing and social services agencies. To support this effort, HHS developed an integrated service delivery system, including technological tools that allow employees to track clients’ case histories across programs, refer clients to additional program areas, and collaborate with other Department caseworkers.

Organizational Reshuffling Creates New Opportunities

Boulder County, the sixth most populous county in Colorado, is home to the city of Boulder and the flagship campus of the University of Colorado system. Within the county government, HHS incorporates programs such as affordable and temporary housing as well as traditional human services and benefits such as the Supplemental Nutrition Assistance Program (SNAP) and cash assistance.

In the past, these services were managed by multiple agencies. But in 2008 the County began a system-wide shift to co-create solutions for complex family and community challenges by fully integrating health, housing, and human services. The idea was to generate a more self-sufficient, sustainable, and resilient community by focusing on reducing the social determinants of poor health, removing barriers to services, and moving the system upstream towards an early intervention and prevention model. 

To catalyze this shift in approach, Boulder County merged its housing and social services departments (creating the HHS) to streamline operations and leverage resources for families receiving services and benefits from the two service areas.

While the unification of the two formerly separate departments represented an initial step toward streamlining service delivery to the residents of Boulder County, agency leadership recognized that integrated service delivery would require – among other things – the development of new technological tools. These tools would support the evolving integrated business model aimed at addressing the needs of Boulder County families.

Using Information to Drive Development

Administrators at HHS wanted to ensure that any new technology tools would be ideally suited to meet client needs, so HHS staff and managers sought to obtain as much data as possible on existing clients in the county.

They had come to understand that by having a comprehensive view of each client’s situation, caseworkers are better able to identify opportunities to apply the early intervention and prevention approach to wrap-around services and help the client stabilize. “We know that 70 percent of our Section 8 (housing choice voucher) clients are also receiving food assistance,” one caseworker said. “So how can we work together with the housing/Section 8 and the food case managers to improve services?” To further broaden the reach of the integrated case management system, county attorneys drafted memoranda of understanding to incorporate community partners such as nonprofits and community health centers.

In addition, through comprehensive data tracking and analysis, clients’ progress could be followed more closely. As administrator recalled, “There was a philosophy of wanting to know, rather than speculate, and be targeted on our outcomes and resources. That’s woven into everything we do.” Technology expertise within HHS assisted in obtaining the existing information from state databases. “We have one of the best people in the state and maybe even the nation in terms of innovative thinking [on] pulling data from systems,” noted one division director.

Leveraging Department Expertise

Shifting to an integrated case management system entailed a significant change in staff roles, and input from personnel was vital in ensuring a smooth transition. One manager, describing the preexisting assumptions among some staff, noted that “any time you’re in a bureaucracy, there’s always a little bit of the attitude that ‘we can’t do one more thing.’”

To solidify support, department leaders illustrated to staff the value of the new service model and technology tools and lifted up program successes. Additionally, the agency’s director conducted regular visits and ‘coffee klatches’ to hear from frontline staff directly. Once staff began to see the progress families and individuals were making as a result of the practice change toward early intervention and prevention and wrap-around services, they began to fully embrace the shift. A child welfare manager noted that it was “through the client successes that caseworkers realized a little bit of effort goes a long way for the clients and makes their job easier in the long run.”

To aid in the development of technology tools, Boulder County established an integrated case management (ICM) team, which brings together representatives from each program participating in the integrated case management strategic work. The team worked together to update the county’s Efforts To Outcomes (ETO) case management software, a tool developed by human services technology vendor Social Solutions. The team began to develop the integrated case management system by looking at the program areas within HHS with the fewest restrictions on data sharing.

Establishing and Building a Pattern of Success

Using the technology tools developed as part of the integrated case management process has helped support Boulder County officials as they begin implementing the Affordable Care Act. Analyzing information shared across the agency, staff are able to identify clients in one program area who may be eligible for subsidized insurance or Medicaid coverage, and can then send out notifications to encourage enrollment. Partly as a result of this, new enrollments in Boulder County through the state’s health insurance exchange, Connect for Health Colorado, have been nearly ten percent of the statewide total, while Boulder County represents just five percent of the statewide population.

In the coming year, Boulder County plans to evolve further toward a “generative model” of housing and human services delivery, working with and empowering the community to be more resilient by strengthening the safety net, maximizing return on investment, and focusing on data-driven decision-making. This effort also entails working with and learning from other agencies around the U.S. that are utilizing similar approaches. As the HHS director said, “More and more we’re seeing that this is the way towards healthy, sustainable, and self-sufficient communities.”

About the Author

Sam Gill, Indi Dutta-Gupta, and Brendan Roach

Sam Gill is Vice President, Indi Dutta-Gupta is Senior Policy Advisor, and Brendan Roach is a Senior Associate at Freedman Consulting, LLC, a strategic consulting firm based in Washington, DC. This article draws upon findings from a paper undertaken with support from the Ford Foundation, entitled “Gaining Ground: A Guide to Facilitating Technology Innovation in Human Services.”

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