Assessing Models of Coordinated Services: A Scan of State and Local Approaches to Coordinating Early Care and Education with other Health and Human Services

Publication Date: June 4, 2021
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  • Pages: 68
  • Published: 2021

Introduction

Research Questions

  1. How do state and local coordinated services approaches coordinate partnerships and service application and delivery?
  2. How do coordinated services approaches intend to reduce barriers that confront families trying to access services?
  3. Are coordinated services approaches that combine ECE, family economic security, and/or other health and human services able to address other child development factors beyond ECE?
  4. What have we learned from efforts to integrate enrollment and eligibility processes for health and human services?
  5. How are they using data to understand service delivery dynamics?
  6. How is public and private ECE funding targeted to meet the needs of at-risk children and families?

To promote children’s healthy development and give them opportunities to flourish, families need a wide range of support services. These services are often disconnected from each other. Early care and education (ECE) has a particularly fragmented system (National Academies of Sciences, Engineering, and Medicine 2018). Systems with conflicting or duplicative processes and requirements, such as separate enrollment processes that ask families to give the same information to multiple providers, place a burden on families—a burden that can be particularly hard on those in crisis (Adams and Heller 2015; Adams et al. 2015; Cavadel et al. 2017).

A growing number of states and localities are working to address the many needs of families living in poverty by coordinating their services and funding streams. Recently, for example, the U.S. Department of Health and Human Services (DHHS) Preschool Development Grant Birth-to-Five (PDG B—5) program awarded funding to states and territories to plan and design a statewide coordinated system of care for young children and their families.

To improve understanding of approaches to coordinating ECE with other health and human services, the Administration for Children and Families (ACF) sponsored the Assessing Models of Coordinated Services (AMCS) project. This report shares findings from a national scan of existing state and local coordinated services approaches.

Purpose

States and localities interested in developing, or continuing, a coordinated services approach for families may not have access to information about the characteristics of such approaches in operation. For example, states or localities may be interested in the types of partners involved in such approaches and their roles, sources of funding and how they are used, the types of services being coordinated, efforts to align eligibility and enrollment processes, and use of data.  AMCS intends this overview to begin to fill that gap. By analyzing the characteristics of different approaches, the study team was able to identify 6 preliminary “models” of coordinated services (see findings). These models are exploratory categories defined by characteristics that coordinated services approaches have in common with each other. Individual coordinated services approaches were often not intentionally following a particular model.

The scan is a first look at the characteristics and potential models of coordinated services at the state and local levels. This scan was not designed to be representative, and notably, coordinated services approaches without publicly available information might not have been identified. Findings presented in this report are preliminary and not generalizable. Additional field work conducted under AMCS will seek to further increase understanding of coordinated services approaches and refine the potential models described in this report.

Key Findings and Highlights

Based on an analysis of 55 approaches (see methods), the study team identified 6 preliminary models of coordinated services (highlighted below). Three preliminary models describe approaches operating at the state level and three describe approaches at the local level. These models are exploratory ways to categorize existing approaches with similar characteristics, but the coordinated services approaches in the scan all had unique aspects to their coordination. Four local approaches did not fit neatly into a particular model. These four coordinated services approaches (which included two federally-funded Promise Neighborhoods and two that were not connected to any state or federal programs) had some characteristics of multiple models.

State Models of Coordinated Services

  1. State vision (6 state-level approaches): Under this model, states had an overarching vision that outcomes for families would be enhanced through alignment of services for parents and children. Approaches that fit this model commonly pursued administrative and policy changes to facilitate coordination, but many of the details about how to implement the state’s vision for service alignment were determined at the local level.
  2. State framework (12 state-level approaches): Coordinated services approaches that fit the state framework model were primarily developed through legislation to improve outcomes related to children’s health and school readiness. This legislation typically included language that dictated the structure of, or framework for, their governing bodies while allowing for variation at the local level.
  3. State direct services (6 state-level approaches): In a state direct services model, the state was directly involved in coordinating services by offering specific services for families. Often, approaches that fit the state direct services model also contained elements of other models of coordinated services, such as the pursuit of administrative and policy changes.

Local Models of Coordinated Services

  1. Hub model (16 local-level approaches): Coordinated services approaches that fit a hub model used strategies designed to increase families’ access to necessary services, from the moment families were identified and throughout their engagement with the system. Approaches that fit this model commonly used strategies like “no wrong door” intake processes, co-location, and joint case management so partners could have a more complete picture of families’ needs and coordinate service delivery. Typically, hub models involved a large number of partners.
  2. Regional network with backbone (5 local-level approaches): In the regional network with backbone model, coordination was primarily administrative and focused on data. In this model, a lead, or backbone, agency coordinated services with the goal of improving community-wide outcomes. The backbone agency’s responsibility was largely to be a convener and organizer of community service providers across a wide range of ECE and health and human services.
  3. Narrow coordination (6 local-level approaches): Coordinated services approaches that fit this model tended to involve between two and eight partners working closely together on a specific service, such as workforce development or literacy programming for the parents of children enrolled in a specific early childhood education center.

Additional detail about the models and cross-cutting themes related to the research questions are described in the report.

Methods

The national scan had three primary activities:

  1. A review of public information (November 2018) to identify state and local coordinated services approaches that met study criteria. The scan of public information identified 95 state and local coordinated services approaches, including 27 state-level approaches and 68 local-level approaches.
  2. Development of profiles (January 2019) to systematically capture publicly available information about key features of coordinated services approaches, such as the partners and services involved in the approaches. The research team consulted with ACF to select 61 approaches for which to develop draft profiles. These were then sent to the approaches for verification and additional information.
  3. Verification of publicly available information (October 2019) by asking points of contact at a set of coordinated services approaches to review the profiles, confirm or correct the information they contained, and fill in gaps in knowledge. Ultimately, the research team received 40 profiles that were verified by representatives of coordinated services approaches and met criteria for the scan.

The research team coded and conducted a thematic analysis of the 40 returned profiles to identify models of coordinated services. After developing the models, the research team coded and categorized the 15 draft profiles that were sent out for verification but not returned. The analysis is based on 55 approaches (24 state and 31 local).

Citation

Baumgartner, S., Cavadel, E., & Allison-Clark, K (2021). Assessing Models of Coordinated Services: A scan of state and local approaches to coordinating early care and education with other health and human services, OPRE Report #2021-89, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Glossary

ECE:
Early care and education
Coordinated services approach:
a coordinated services effort by any individual program or a group of programs, an agency, department, or other organization focused on coordinating services for low-income families, at the state or local level.
Model of coordinated services:
exploratory category that describes characteristics that coordinated services approaches have in common with each other, based on information gathered in a national environmental scan. Individual coordinated services approaches were often not intentionally following a particular model.
PDG-B5:
Preschool Development Grant, Birth through Five.