Table of Contents

  • Every society has vulnerable people. People who need multiple supports, day-to-day, to address personal challenges like extreme poverty, poor physical or mental health, and low education, and to offer them the best chances of turning their lives around. Every vulnerable person represents a social challenge, a moral responsibility, and a life that can be better lived. For governments, the costs of treating vulnerable groups is high. Lost opportunities for work and productivity, high social services costs, and long-term benefit dependency – from generation to generation – reduce the economic potential of a society and place a burden on social development and public budgets.

  • Many vulnerable groups have complex needs, which require multiple interventions. Providing adequate and varied services to address these costly and complex needs is a challenge for all countries of the OECD.

  • This chapter provides the conceptual framework for the integration of social services. It defines different forms and levels of integration and outlines the rationale for integrating social services for vulnerable populations with complex, and often acute, service needs. It then presents the potential benefits of integrated services for both service users and providers from a general perspective, including cost effectiveness and cost savings, better access to, and take-up of social services, and improved service quality and service use outcomes. The chapter concludes by discussing barriers to effective integration, such as fiscal federalism and incentives for shifting costs and/or clients between providers, uncertainty in outcomes, challenges related to service administration and joint working between providers, data sharing and stigma.

  • Family vulnerability is a growing problem across the OECD. Vulnerable families and children are disproportionately affected by the current economic downturn and their number is growing in many OECD countries. Attempting to respond to these concerns, several countries have taken measures to address the complex needs of this group by bringing different services together. Drawing on these integrated family service initiatives across the OECD, this chapter seeks to answer the following questions: how are services integrated within existing family welfare structures? Are joined-up family services effective in preventing cycles of disadvantage and social exclusion? This review finds that different forms of integrating service delivery have the potential to improve service-use outcomes for families with multiple needs. The lack of robust evidence on the (cost) effectiveness of these initiatives, however, hinders long-term investment and upscaling of existing initiatives.

  • Mental ill-health affects many individuals, and represents a large and rising burden of disease across the OECD. Episodes of mental illnesses for many people begin in childhood or young adulthood, and can contribute to vulnerable situations, such as low educational attainment in the first instance, or unemployment or financial hardship in the second. While OECD countries are increasingly investing in developing cross-sectoral approaches to promote mental well-being, the education, employment or social sectors most involved with children and youth often lack the capacity or expertise to effectively address the complex needs associated with mental health concerns. This chapter discusses the challenges of, and opportunities for, integrated delivery of services to improve outcomes for children and young people with mental health needs, and presents some good-practice examples of policies 1) to promote mental well-being in schoolsettings and 2) to tackle inactivity in youth with mental health problems.

  • Although international comparisons of homelessness require cautious interpretation, OECD-wide evidence suggests that up to 8 in 1 000 working-age adults have no stable accommodation at any one time, and around 8 to 10% of families, on average, have difficulty meeting their housing costs each year. Experiences of homelessness can vary from longer term, chronic forms, to more hidden or transitional experiences. Addressing homeless individuals’ needs requires multiple – and often expensive – service interventions, especially when treating the most chronic cases. How and when the needs of the homeless are met will affect human lives and social costs. While several OECD countries are developing innovative “housing first” approaches to address homelessness, temporary shelter and emergency services remain the dominant model of provision, despite their limited capacity to facilitate sustainable exits from homelessness. This chapter addresses the challenges of measuring homelessness across OECD countries and discusses the issues salient to delivering effective housing and social services to those at risk of, or experiencing, homelessness.

  • As their populations age, all OECD governments are confronted with increasing demand for health and social services. The inefficient (over)use of services by the frail elderly, who suffer from physical and functional disabilities, puts additional pressure on scarce public resources. Drawing from evidence on integrated models of care across OECD countries, this chapter examines the potential of these innovative service delivery methods to provide effective and cost-efficient care for frail elderly individuals. The chapter also discusses barriers and perverse incentives to effective implementation created by traditional service delivery structures. Whilst highlighting the need for better measurement and further evaluation of integrated care, findings illustrate the potential of integrated service delivery models to respond to the frail elderly’s complex needs, and offer some promising ways to promote integration at both the governance and delivery levels.

  • Governments across the OECD are experimenting with innovation in the integration of social services for vulnerable groups, despite a lack of detailed evidence in support of specific approaches or implementation practices in this area. To facilitate future policy development, this chapter sets a scene for successful delivery of integrated services based on the varied service integration policies, targeting different vulnerable groups, outlined in this report. The chapter includes a discussion of the main challenges to, and opportunities for, integration of social services, and concludes with a section outlining evidence on what works, promising practices for policy experimentation in the area, and cautions regarding expectations for returns from integrating social services for vulnerable groups.