Connecting Silos � From Food Stamps to Free Check-ups

Aug 23, 2011, 2:15 PM, Posted by NewPublicHealth

How do you meet the needs of a teenager who’s been suspended from school, has suicidal tendencies and has a mother with drug problems? How about a non-English speaking woman with tuberculosis, preschool-aged children, unstable housing and potential domestic violence issues? Or a homeless man with diabetes? In most cases, the social services that address needs like this – public housing, food stamps, temporary cash assistance – are silo-ed from each other and from health and public health services by funding streams, staff divisions and a lack of communication. Efforts to make health and human services work together take a whole-person approach to delivering care – and it takes a village.

The Public Health Informatics 2011 Conference included a session on how local health departments are working to advance the continuum of care by connecting public health, health care and social services. Social services provide basic needs – housing, affordable healthy food – that have a big impact on health, yet these systems often don't work together to support the end user. NewPublicHealth is on the ground with Public Health Informatics conference coverage this week .

Getting Health and Social Services Systems to “Talk” to Each Other

Daniel Stein, Stewards of Change cofounder, talked about the challenges of getting human services, health care and public health to “talk” to one another when they’re spread out across different systems, programs and agencies that all have different architectures, funding streams and approaches to problems.

Interoperability is the key, said Stein. What’s interoperability? Stein said just think of Expedia or Travelocity. These sites represent interoperability in action – pulling from varied systems with different databases and architectures, finding common terminologies to integrate them, and offering a single, usable interface where all of the information can be used at once.

Stein said the technology and data capacity exist to consider all the facets an individual has to deal with and serve whatever need they have from any entry point, whether they come to the system through Medicaid or a food stamp program. Stein pointed attendees to the U.S. Department of Health and Human Services Administration for Children & Families Interoperability Toolkit as a starting point.

A Model for Bridging Social and Health Services: Montgomery County

Uma Ahluwalia, Director of the Montgomery County Department of Health and Human Services, reported on how her county is pushing the boundaries – by erasing the boundaries – between health and human services. Ahluwalia said that while Montgomery County is perceived as the wealthiest suburb of Washington, DC, the demography is shifting. Between FY07 and 2011, food stamp application increased by 126% and temporary cash assistance applications by almost as much. Applications to the Medicaid Families and Children program rose from 39,000 to more than 65,000 in the same amount of time.

When Ahluwalia took on her role, 126 different systems were in place to meet the needs of her constituents’ health and social wellbeing. She implemented a multi-department funding initiative to get modernize their technology, and get the different systems to speak the same language. This includes health information exchange to work with hospital and lab data. Her department is also working with local hospitals on the Community Benefit (through hospital funding – critical when public health budgets are so tight) to collect community data. They’re also developing a common client index and integrating electronic health records with social services records, to support better communication between programs. The goal is that there will be “no wrong door” – people can enter the system from any access point and get the exact same care, across the range of their social and health needs.

It’s a work in progress, said Ahluwalia, and there are still barriers – every program still brings its own case management, care coordination staffing and standards and it can be difficult to coordinate across them, especially with a limited budget. Questions arise, like which department takes the lead on which case? How do teams work together with very different culture and terminology used between staff like social workers and behavioral health professionals? Each brings a very different expertise to the table, said the director, and each needs to be there – it’s just about figuring out how to work together. A practice model and set of protocols is in process to help guide the staff in navigating the waters as these silos are bridged.

>> Continue to follow NewPublicHealth coverage of the Public Health Informatics 2011 conference here.

This commentary originally appeared on the RWJF New Public Health blog.