This final report describes the design, implementation, and evaluation of the Iowa Patch project, which was undertaken to improve the quality, accessibility, and accountability of social services to children, youth, and families in a small "patch," or geographic area, of Cedar Rapids. By the end of the project, services had been integrated and improved, a community-based interagency service team had been developed, and agency turfism had been reduced. The patch team, including line workers, were more likely to use assessment tools as a team, to share tasks, and to support one another with greater role flexibility. The focus of services shifted from a crisis orientation to a more preventive, proactive approach.
A 3-year demonstration grant was provided to the University of Iowa by HHS's Administration for Children and Families. Its purpose was to overcome categorical barriers that prevent the pooling and use of resources to deliver flexible services that build on the strengths of individuals, families, and neighborhoods. As defined by its advisory committee, the Iowa Patch project's goal was "to improve the quality of life of children and families by providing accessible services that are responsive to family and individual needs in the context of the consumer's local community, developing the existing resources and building on the strengths of the neighborhood."
Funded from October 1991 through September 1994, the project replicated elements of the patch system of community-centered service delivery developed in the United Kingdom during the 1970's. Teams of human services workers with different levels and types of skills were placed in neighborhood offices that served about 10,000 people in Linn County, Iowa. Using a community-oriented approach to social work practice, these teams were able to provide more accessible, flexible, and holistic services based on their knowledge of the local cultural and physical environment and on the formal and informal relationships they established.
In Iowa, patch was viewed as a concept that, if appropriately replicated, could complement other approaches to system restructuring, including the Child Welfare Decategorization project that was developed to reshape the service system. Selected Iowa counties, including Linn County, were permitted to merge their share of various funding streams into one child welfare fund. From the outset, the Iowa Patch project was adopted as an initiative of the Linn County Decategorization project. The demographics of the 9,921 residents of the patch area included higher rates of poverty, unemployment, child placement, single-parent homes, and poor housing than those in the rest of Cedar Rapids or in the State. Many children and families had multiple needs, and human services agencies were heavily involved in the communities at the project's outset.
To achieve project goals, a patch process model was designed and implemented using five primary methods: (1) integrated governance involving agencies, community organizations, neighborhood residents, and service users; (2) localized service delivery; (3) a core interagency team generating new roles and methods; (4) an extended team coordinating service delivery across a wide range of other public and private organizations; and (5) a single point of entry to the service network so consumers could access help with fewer barriers.
A logic model was developed for the project evaluation that included problems endemic to service delivery in the United States; substitutionism (formal services substitute for, rather than support, informal systems of care); turfism (agencies protect their service domains); fragmentation; unresponsiveness to local conditions and consumer needs; deficit orientation (a focus on weaknesses rather than strengths of families and neighborhoods); crisis orientation; and bureaucratic rigidity.
The evaluation focused on three aspects of the project:
- The geographic and demographic profiles of the patch area were taken from block-level statistics from the 1990 U.S. census.
- The process and results of Patch team development were assessed through focus groups, a 1-year participant-observer study of the team, and a questionnaire completed at the beginning and end of the demonstration period. The questionnaire was also administered to a comparison group of direct service staff in another county.
- Systemic impacts of the project were studied through two sets of personal interviews with senior administrators of agencies directly or indirectly involved with the project, through focus groups, and through the administration of a brief paper-and-pencil assessment with the same administrators.
The project demonstrated the feasibility of integrating services through a neighborhood-based, collocated interagency team of human service workers representing both public and private nonprofit agencies and was accomplished without a large input of new resources.
The patch approach to practice and service delivery reduced problems of fragmentation, deficit- and crisis-orientation, bureaucratic rigidity, turfism, and substitution of formal for informal systems. Researchers observed the interweaving of formal and informal supports, innovative resource mixes, and consumer and citizen involvement. More emphasis was given to prevention, early intervention, and increasing collaboration among service workers. Putting a local team in the neighborhood made human service workers more accessible, more approachable, more able to develop informal relationships with consumers, and more able to establish and work with informal helping networks.
After the grant ended, the Patch project was integrated into an initiative to develop family resource centers. The project established a strong desire to maintain and further develop the patch approach and a commitment to support it financially and administratively.
Use of Results
For State or county agencies with statutory responsibility for the protection and welfare of children, the patch process offers an innovative approach to building new partnerships. It may be appropriate for replication in other geographic areas, in other populations, and in other types of service delivery systems. The findings also have implications for institutions that educate human service workers in terms of developing curricula, field placements, and research opportunities that prepare faculty and students for integrated practice models such as patch.
Administration on Children, Youth and Families
PIC ID: 5977
University of Iowa, Iowa City, IA