For much of the last year, CHRT has been working with The Kresge Foundation and other national partners to better understand and advance the concept of health and human services integration.
At CHRT, we are focusing our health and research transformation lens and our expertise in systems change to learn about the challenges and opportunities that occur as organizations work to connect historically separated systems to improve the health and socio-economic opportunities of communities. Throughout this work, we are mindful of the critical importance that racial inequities play in individual and community health and well-being.
Working on health and human services integration during and through the COVID-19 crisis, our team is learning at an accelerated pace. Our awareness of barriers and policy issues are heightened as we see the real-world impact of this pandemic.
Here’s what we’re learning:
Our most vulnerable citizens are at greatest risk: The negative effects of this pandemic are falling disproportionately on our most vulnerable citizens—people who struggle to earn enough to live on; to maintain a roof over their heads; to stay clean and sober; to maintain their mental health; to feed themselves and their families; to be safe from violence—all while trying to keep safe from a deadly virus for which there is no vaccine or cure.
The pandemic is exposing and exacerbating racial inequality: In Michigan, 40 percent of COVID-19 deaths are among our African American residents, yet they are only about 12 percent of the population. Why is that? Health, and alternatively, vulnerability to a devastating virus, is not something that happens in isolation. It is impacted by historical and structural inequalities that have been shaped by racist policies and practices and the lack of economic and social mobility that came along with them.
The ability to share data safely, securely, and meaningfully is key: In order for health and human services systems to effectively address the complex, multi-faceted needs of individuals, information needs to flow across systems, programs, and agencies. Such information can help to identify which individuals and families need extra support and can support ‘no-wrong door’ approaches for them by using universal enrollments, assessments, and protocols.
Tele-health has expanded, but it is re-exposing our digital divide: Until recently, expanding tele-health existed mostly on health care wish-lists. Now it has been thrust to the forefront of health interventions. As CHRT senior analyst Karen Teske points out in a timely April, 2020 publication, since the beginning of the year 80 additional services are now billable through Medicare for telehealth with a certified clinician. But even as we see tremendous progress, we ae mindful that disparities in access to high-speed internet determine how effective tele-health is as a means to deliver care and services—rural communities, lower income households, and older individuals are far less likely to have the high-speed internet that makes effective use of this innovation possible.
Right now, and far into the future, we need our health and human services systems to:
- Share information, reduce duplication, and create and maintain an organizational culture that puts people at the center.
- Address health while at the same time addressing the social determinants of health, racial inequalities, and barriers to social and economic mobility.
- Implement more culturally competent, trauma-informed practices and ‘no wrong door’ approaches to ensure people can get the services and resources they need, when they need them, delivered in ways that elevate, rather than marginalize.
Across the country, more and more organizations are examining and talking about their integration work, but we are coming to recognize that true integration is often difficult to achieve.
While consolidating offices or administrative tasks and collaborating on individual programs may be part of an integration framework, achieving real health and human services integration means unwinding entrenched systems, reintegrating the cultures of organizations, the data systems they use, the funding streams they require, and the governance structures they depend upon—all while recognizing that social determinants are inseparable from the health and wellbeing of people and communities.