When it comes to service delivery, just about everybody in government complains about bureaucratic silos. A call to one department about a particular issue -- how to sign up for a new benefit program, for instance -- can lead to several more in a frustrating effort to get an answer.
But silos are beginning to be toppled, at least in the human services arena. Cities and counties are moving to consolidate their health, housing and human services departments. And even where agencies aren’t merging formally, there is a sense of cooperation among departments that simply didn’t exist a decade ago. So-called “no wrong door” policies are increasingly common.
A new federal grant program aims to foster and build on that cooperative spirit. A three-year, $3.6 million grant program, a collaboration between the Department of Health and Human Services and the Department of Housing and Urban Development, is providing five localities with help in merging their data systems for HIV care and housing. It has long been known that people living with HIV who are unstably housed are less likely to stay in the kind of care needed to suppress the virus. The pilot -- evidence itself of a little silo-busting at the federal level -- is a crucial step in coordinating these services to provide better care.
The HIV treatment side of the pilot is already well established. For 26 years, the federal government has funded the Ryan White HIV/AIDS Program, which provides health and support services for uninsured or underinsured people living with the virus. For the city and county departments that are awarded funds under the pilot program, the grant is helpful because Ryan White coordinators and housing officials often serve the same clients.
That’s a reality that one of the grantees, the Kansas City Health Department, has been dealing with for some time. “We are really fortunate to have strong partnerships between Ryan White and housing departments,” says Jamie Matney, quality and housing manager for the department’s HIV services program. “We have a Ryan White planning council, and housing officials sit on that council. But still, despite that, we haven’t been able to get any really hard data between the two of us.”
In Palm Beach County, Fla., coordination between housing and Ryan White officials has been moving “really slowly” due to technical and logistical issues, says Geoff Downie, a program manager for the county Department of Community Services. The hope is that the new grant will help jump-start that coordination.
Certainly it’s too soon to tell what impact merging HIV services and housing will have for the grantee localities and their clients. But at the very least, officials feel confident that it’ll reduce inefficiencies and help them get clients into stable housing more quickly. “We have people who have been on housing waiting lists for seven to 10 years,” says Downie, “so we want to build a flow to give people assistance when they need it. Also, we need to streamline the eligibility processes so people can qualify for Ryan White and housing at the same time.”
Of course, the ultimate goal is better care for people living with HIV. “We’re going to take this group of unstably housed folks and figure out how many are going to the doctor [and] how many are taking their meds and suppressing their virus,” Matney says. “The phrase ‘housing equals health’ is spoken a lot, but now we’re really going to demonstrate that.”