Liesl Wendt:In August and September, health and human service organizations in Oregon and SW Washington were invited to participate in focus groups and an online survey designed to gather information about how front-line staff access resources and services to meet their clients’ needs. The project was sponsored by a broad spectrum of nonprofit and government agencies including:211info, The Coalition of Community Health Clinics,The Portland Housing Bureau, Multnomah County’s Department of County Human Services, Cash Oregon, NPower Northwest, The Portland Office of Emergency Management, Street Roots, and The United Way of the Columbia-Willamette.We had been in conversations with several like-minded organizations recognizing that communication is changing rapidly and we wanted to be responsive to how people were needing information. We don’t have an unlimited budget so how and what investments should we make? We have long recognized ourselves as part of a much broader social service system. How can we leverage each other’s efforts in a much smarter way headed into increased need and diminishing resources? Is there a better way to manage information and provide it to the people who need it? That’s the question we were asking at the same time as many other organizations. So…we thought let’s go talk to front line workers…how are they getting information now and how do they want to get information.Knowing we wanted to do more than just talk to the people who are happy to talk to us, we hired Kris Smock to help us reach a broader group. We wanted to hear the good, bad and new ideas. We also wanted to talk to two other groups ourselves. One group was comprised of youth (thanks to the outreach skills of my two teenage children) and one was a dynamic group of community leaders that explored some big picture ideas. Matt Kinshella from 211info, will brief you quickly on those efforts before Kris examines the official study. Then, at the end, we will have an open Q&A to discuss anything you’d like. But first I wanted to tell you a story that will help frame our conversation.
Liesl Wendt:Iwant to tell you about a caller to 211info last week….For the sake of telling a story, I’ll name her Mary.Mary called looking for help with rent assistance. She had been given a piece of paper titled Community Resources and saw 211’s number. She is 7 months pregnant and had been a manager at a convenience store but since she couldn’t work as many hours as she used to, she was making less income. She couldn’t make rent in October and had until the end of month to figure it out. Her dad was going to help her but his situation changed and he couldn’t any longer so she needed help to the tune of $500. Mary reached out to the tools she was aware of:FriendsPaper and A phone call
Liesl Wendt:For her zip code, the only referral with available resources the day she called was St. V’s and they typically only help with $100.In order to help stretch her resources she was also referred back to her DHS worker to have them recalculate SNAP benefits based on new income info. We also provided:Energy assistance referralReferral to a few food box agencies.Throughout the call, she kept repeating, I’ve never done this before and asked for clarity on how to proceed. Mary’s story is a very typical one for 211 and probably many community agencies.When the call ended, I first felt great appreciation for the patience of our call takers! And, I was overwhelmed by Mary’s plight. I wondered if she would be able to make all the contacts and get connected to the variety of services that may, operative word, may be able to help her. As Kris and Matt unfold their findings keep Mary in your mind. The duel sense of appreciation and apprehension I felt after hearing about Mary’s plight mirrors and overall sentiment felt by our study participants. Please welcome Matt Kinshella.
Matt Kinshella:We went in to this focus group of 9 teenagers with the goal of finding how they might access services, or encourage a friend to do so if they needed help. How would they do it now and how did they imagine the future would look like. I expected, after some degree of reticence, they would be talking about facebook, Tumblr and post secrets as ways to engage youth. But in fact the group varied widely on the tools. Some thought live chat would be weird. Others figured calling would be convenient. Others didn’t even mention electronic tools.No what came out was much simpler. No matter what tool it is, they have to trust the people behind it.In a way this anchor of trust made a lot of sense. Since most of these kids can remember there has been a new website or device every week. Those things come and go. Where as adults often get caught up in the newest shinny thing (whether they are scared or it or whether they worship it) “newness” is expected.
Matt Kinshella:Last week, 211info hosted an “Innovation Luncheon” where we invited friends and partners to help us cook up new ideas. We were joined by our pals at Street Roots, an economist at ECONorthwest, our partners at the Oregon Department of Human Services and about a dozen others. What emerged wasn’t an idea about the next new tool, but rather an old fashioned notion with a digital twistDuring our lunch discussion, it became clear that we need a community solution.The bulk of our social service system is designed to help when informal networks, such as family and friends, are tapped out. But what happens when that system itself is tapped out? When the unavoidable bill finally comes due, when the unexpected life event hits, when unemployment runs out, when an addiction gets out of control, people need a new place to turn.Technology can be that bridge to form new human connections based on shared experiences and generosity. One of our lunch participants talked about social media as a “gathering place” much like the local market or town square.We can use social media, and agencies like 211info, as a unified way to connect people to information in the manner many have come to expect in the digital marketplace. (Think Yelp, Trip Advisor and Groupon). We can create channels where it’s easier to share experiences and facilitate peer problem solving. We tap into neighborly willingness to help and forge new relationships.One of the most insightful comments came from Ash Shepherd, a tech consultant from NPowerNorthwest when he pointed out that some of the coolest innovations are happening with relatively old technology – like texting. Echoing the sentiment of the youth focus group, the tools where not the focus of the conversation, but rather how do we build a sense of interconnectedness and community that encourages us to relate better to one another. You’ll here from Kris about some suggestion service providers had for adding tools to make things happen more efficiently. However, yet again, the tools weren’t the focus, but rather a deeper yearingat the root of a lot of the issues. I’ll let Kris Smock and Liesl elaborate more.
Kris SmockThe study consisted of four focus groups held during a two-week period in August, with 18 participants.This was followed by an online survey in September, with 193 respondents.The focus group participants and survey respondents included case workers, outreach workers, receptionists, information and referral specialists, health clinic staff, and managers from a wide range of organizations. Their input provides valuable insights into how staff access information, the barriers they face, and the tools and systems changes that would enable them to more effectively address their clients’ diverse needs.
Kris Smock:The first question we asked respondents is how they access information about available resources to meet their clients’ needs. The most common responses included:Networking and information-sharing with colleagues within their agency and with staff from other agencies;Databases and resource binders developed in-house or compiled from other organizations’ printed information sheets and brochures; Google searches and searches of other organizations’ websites;Web-based resource guides such as 211’s website, Resources Galore, and the Coalition of Community Health Clinics website; andPrinted resource guides such as the Rose City Resource Guide and 211’s resource book.
Kris Smock:One of the issues that we were particularly interested in learning more about was how staff use electronic tools to find information on resources to meet their clients’ needs, and whether new electronic tools would be useful to them. This table shows the percentage of survey respondents who said they use various types of electronic tools.What we discovered is that human services staff are not dinosaurs – many of them use the internet to access information. But relatively few of them use social networking sites or cell phone applications.56% use Google searches44% use 211’s website and 41% use other organizations’ websites16% use issue specific websites8% use social networking sites, and1% use cell phone applications
Kris Smock:This table shows how the most popular electronic tools from the last slide (shown in red) compare to more traditional tools (shown in purple)81% of respondents rely on networks and relationships with staff at other agencies, and 61% rely on suggestions from colleagues,vs. 56% who rely on Google searches45% use printed information sheets and brochures from other agencies, whereas 44% use 211’s website and 41% use other organizations’ websites
Kris Smock:Once staff have found information about resources or services to meet a client’s needs, it is often up to the client to follow up on the information in order to access the services. For this reason, even though many staff use electronic tools to find information, they also rely onprinted information that they can hand out to clients. This includes one-page information sheets, information printed from websites, and the Rose City Resource Guide. Many participants acknowledged the limitation of just providing clients with phone numbers and information and expecting them to follow up. Some staff try to do as much as they can to assist the clients in making the connections, but most staff said they don’t have enough time to provide the level of support that clients may need, and they don’t always have the knowledge or relationships with the other service providers that would enable them to provide the kinds of “warm” referrals that are most useful.
Kris Smock:We asked respondents what barriers they face in getting information and connecting clients to resources.The most common barriers were:Lack of resources and services to meet clients’ needs. It’s hard to connect clients to resources when those resources don’t exist or are stretched so thin that clients are unable to access them.Lack of real-time information on resource availability: It is difficult (and sometimes impossible) to get up-to-date, real-time information on what resources are actually available on the specific day that the client is looking for them. The lack of real-time information means clients can feel like they’re getting the run around, and may be sent to agencies that can’t ultimately help them, leading to frustration among clients and agency staff.Many respondents said they don’t have enough time to provide clients with the level of one-on-one attention and follow up that they need. Organizations often operate in issue silos, which can make it hard for staff to have adequate knowledge about other service areas or relationships with staff across issue areas.Online information and referral tools are often hard to use, with search engines that are not intuitive or user friendly; and They are not always accurate, with out-dated or incomplete information, leading many staff to no longer trust the information that they get from those tools.
Kris Smock:So what strategies and tools would help staff to overcome these barriers and strengthen their efforts to connect clients to resources?We asked focus group respondents to brainstorm potential strategies, and we also asked for their feedback on a starting point list of potential ideas that we put together. Then we took the most popular ideas from the focus groups and posed them to the survey respondents, asking them to rate the ideas as very useful, somewhat useful, neutral, or not useful
KRISThe most popular ideas – those rated as very useful by the majority of respondents -- were:One-page, topic-specific information sheets about local health and human services resources, available online and printable – 80% of respondents rated this as very usefulAn online tool that allows users to create customized, printable, easy-to-read information sheets about resources, highlighting just the information the user needs – 62% of respondents rated this as very usefulAn online health and human services database that allows service providers to edit and update their agencies’ service listings directly, in real time – 59% of respondents rated this as very usefulA small, printed resource directory updated quarterly or annually –58% of respondents rated this as very useful;Easy to use online translation tools that enable users to translate information and referral materials into multiple languages – 51% of respondents rated this as very useful.
Kris Smock:In addition to specific tools, respondents identified other changes that would support their efforts to connect clients to resources. The most common were:Real-time information on service availability that allows service providers to track on a daily basis whether and where a particular resource is available.Greater systems alignment: Create strategies to reduce issue silos and better connect complementary service systems in a more structured way. Relationship-building: Many respondents identified networks and relationships as the most essential tools for effectively connecting clients to resources. But many respondents also said they do not have time to go to additional networking meetings. We need to look for creative strategies that allow staff to connect with each other without further burdening their already stretched schedules.Improve web search engines and interfaces: Respondents expressed frustrations with the 211 website and other web-based information and referral tools, and they made a range of recommendations about how to make the interfaces and search engines more effective and user-friendly both for staff and for clients.I’m going to let Liesl provide closing remarks and there will be some time for a Q&A at the end.
Liesl Wendt:We heard ideas about more real time information, more detailed information and a better relationship with other Providers and complex system integration. These ideas are not new in and of themselves but what can't be captured in a data report is the emotion and urgency front line service providers felt. This isn't an esoteric need. This needs to happen now because more and more of our communities members are in crisis. And much like tools weren’t the first concern of the youth, or of community leaders, the tools weren’t the biggest take away from service providers.The big lesson we came away with, both in the words our participants spoke and in the frustration in their voices was that people feel disconnected with each other. They feel isolated and they feel overwhelmed. But they yearn to break down silos and combine efforts - not to make their own lives better but to bring aboutimprovements in the system. I've heard from more partners and funders then I can count that we need new thoughts. But without the mechanisms to combine new ideas and pilot new projects the people we all serve will suffer. My goal is that when we look back a year from now more of the people we interviewed will be able to point to concrete gains in our system and community interconnectedness. We will take heed and we will be changing some of our service delivery models:211info will take a leadership role in being this gathering place. This series of focus groups and other meetings you've heard about today are only the beginning. We will continue to host in person meetings with front line staff, community and organization leaders and clients. We are in the beginning stages of changing how we approach updating our resource information. We are changing from a back-end approach to a front-end approach and getting our resource team out in the field to build relationships with program managers with the goal of more real time information. We will sacrifice the quality of our least referred to agencies in doing so but we hear the need for more detailed and availability information from agencies that provide, rent and energy assistance, food, health care and early childhood services. We will be focusing on nimble, open source databases and web based software that can be quickly improved and integrated with other organizations. Already, we are exploring partnerships with several of our partners on this project to integrate backed operations to give clients a more seamless and insightful contact point with community services and health care. Ex. Coalition of Community Health Clinics This is a start but we will continue to seek opportunities for pilot projects and new ideas. Well be exploring setting up online spaces for people to gather innovativeideas, and we welcome anyone in this room or around the state to utilize our skills and drive to try out that idea you've always wondered about but never knew how to make a reality. Even if we can't directly help you, we welcome these conversation and we likely know others who you could partner with. So, we do have a wish list: 1) Onbehalf of the callers we hear from and the agencies that help them, we’d like to see more streamlined approaches to accessing services, more coordinated approaches to assisting people in need, more comprehensive programs, more clarity on availability and access procedures, more willingness to fund pilot projects and system linkages. 2) While funding is a huge challenge, we can do things differently with the resources we do have and we can be much willing to work together to highlight what does work and problem solve what doesn’t. Right now, someone like Mary is on her own to navigate a maze of services. 3) In the future, how can we provide a more straight forward path to her ability to stay a healthy community member? We’ve got some ideas but headed into the future, we’re ultimately hoping we can also offer a place to foster new solutions. If we keep in the mind the notion from Steve Johnson’s new book, Where Good Ideas Come From, that innovation happens not through one stroke of genius but rather many small ideas combining to spark brilliance, we can make significant impacts for the most vulnerable in our community. Bring on the ideas, big and small!
Health and Human Service Provider Study Results
Health and Human Service ProviderFocus Groups and Survey
Focus Groups Survey• August 2011 • September 2011• 18 participants • 193 respondents
How do staff access information? Networking and information sharing In-house databases and resource binders Google searches and other organizations’ websites Web-based resource guides Printed resource guides
Electronic Tools vs. Other ToolsNetworks and relationships with staff at 81%other agenciesSuggestions from colleagues 61%Google searches 56%Printed information sheets and brochures 45%from other agencies211 website 44%Other organizations’ websites 41%
What barriers do staff face? Lack of resources to meet clients’ needs Lack of real-time information Not enough time Issue silos I&R tools are hard to use and not always accurate
What tools would help?http://www.flickr.com/photos/spence_sir/
Tools rated as very usefulOne-page topic-specific information 80%sheets available online and printableOnline tool that allows users to create 62%customizable, printable info sheetsDatabase that allows providers to update 59%information directly in real timeSmall, printed resource directory 58%Online translation tools 51%
Other recommendations Real-time Greater Relationship- Improve webinformation systems building search on service alignment engines and availability interfaces