Pursuant to a congressional request, GAO reviewed federal, state, and local government approaches to integrating the delivery of health, educational, and other social services to at-risk families, focusing on: (1) barriers in the design and implementation of the various approaches; and (2) policy options for future federal initiatives.

GAO found that: (1) service-oriented delivery systems attempt to provide services by integrating and consolidating health, educational, and other services without altering existing program or funding structures; (2) two Head Start system-oriented initiatives attempted to create new organizational structures, develop multi-agency service plans, and develop multi-service budgets; (3) both initiatives failed due to a lack of agency support, insufficient consensus on problems and solutions, a lack of effective administrative structure oversight, political leadership and support changes, worsening fiscal conditions, and conflicting agency ideologies; (4) other Head Start service-oriented projects were able to link at-risk families with comprehensive services by improving cooperation between program officials and service providers, providing incentives, mediating program goals and the roles of key personnel, and establishing administrative entities which institutionalize changes and create forums for communication; (5) the projects achieved their goals by offering a variety of services at one convenient location, creating client advocates to manage services, and developing formal and informal service agreements, (6) the projects were able to implement these strategies by educating families about locations of services, providing transportation to local services, and creating packages of support services; and (7) obstacles to agencywide implementation include competition for dwindling resources and delivery of existing services, and missions too far away from the agency's traditional roles.

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