Performance audit, Department of Economic Security, service integration initiative

              Performance Audit
Department of
Economic Security–
Service Integration Initiative
Performance Audit Division
Debra K. Davenport
Auditor General
JULY • 2005
REPORT NO. 05-05
A REPORT
TO THE
ARIZONA LEGISLATURE
The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of five senators
and five representatives. Her mission is to provide independent and impartial information and specific recommendations to
improve the operations of state and local government entities. To this end, she provides financial audits and accounting services
to the State and political subdivisions, investigates possible misuse of public monies, and conducts performance audits of
school districts, state agencies, and the programs they administer.
The Joint Legislative Audit Committee
Senator Robert Blendu, Chair Representative Laura Knaperek, Vice Chair
Senator Carolyn Allen Representative Tom Boone
Senator Gabrielle Giffords Representative Ted Downing
Senator John Huppenthal Representative Pete Rios
Senator Harry Mitchell Representative Steve Yarbrough
Senator Ken Bennett (ex-officio) Representative Jim Weiers (ex-officio)
Audit Staff
Melanie Chesney, Director
Shan Hays, Manager and Contact Person
Monique Cordova, Team leader
Joseph McKersie
Copies of the Auditor General’s reports are free.
You may request them by contacting us at:
Office of the Auditor General
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2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
DEBRA K. DAVENPORT, CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
WILLIAM THOMSON
DEPUTY AUDITOR GENERAL
July 19, 2005
Members of the Arizona Legislature
The Honorable Janet Napolitano, Governor
Mr. David A. Berns, Director
Arizona Department of Economic Security
Transmitted herewith is a report of the Auditor General, A Performance Audit of the Department
of Economic Security—Service Integration Initiative. This report is in response to a November 20,
2002, resolution of the Joint Legislative Audit Committee. The performance audit was conducted
as part of the sunset review process prescribed in Arizona Revised Statutes §41-2951 et seq. I am
also transmitting with this report a copy of the Report Highlights for this audit to provide a quick
summary for your convenience.
As outlined in its response, the Department of Economic Security agrees with the finding and
plans to implement all of the recommendations.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on July 20, 2005.
Sincerely,
Debbie Davenport
Auditor General
Enclosure
The Office of the Auditor General has conducted a performance audit of the Arizona
Department of Economic Security’s (Department) service integration initiative
pursuant to a November 20, 2002, resolution of the Joint Legislative Audit
Committee. The service integration initiative is a major attempt to restructure the
Department’s service delivery approach. Its intent is to improve outcomes for families
served and maximize services provided with the resources available.
This audit was conducted as part of the sunset review process prescribed in Arizona
Revised Statutes §41-2951 et seq and is the fourth in a series of six reports on the
Department of Economic Security. The three reports already issued have examined
the Department’s welfare programs (Auditor General Report No. 04-02), the
unemployment insurance program (Auditor General Report No. 05-01), and
information security (Auditor General Report No. 05-04). Subsequent reports will
review the Division of Developmental Disabilities and analyze the Department based
on the 12 statutory sunset factors.
In 2004, department management issued a new statement of the Department’s
vision, mission, and guiding principles in its strategic plan. Among the new principles
were three that focused on improving the Department’s level of integration: 1)
effective integration of systems of care, 2) service coordination across systems, and
3) partnership with communities. The Department has six divisions that provide many
different services to individuals and families with needs related to a wide range of
factors such as aging, income, unemployment, and disability, and an additional three
divisions providing administrative support. Historically, government agencies such as
the Department that administer federal and state human services programs have
administered services in a “siloed” manner. Although the Department has attempted
some service integration pilots in the past, there has been little or no coordination
between programs administered by different divisions. The current service integration
initiative is designed to change this condition.
Service integration is not a new idea, but the federal government’s 1996 Personal
Responsibility and Work Opportunity Reconciliation Act, which is more commonly
called welfare reform, re-energized the idea because the federal legislation led many
Office of the Auditor General
SUMMARY
page i
states to examine the links between their cash assistance and job training and
placement programs. The Department’s current efforts are comparable with current
trends in other states. Some efforts are system-oriented, emphasizing organizational
reform; others are service-oriented, emphasizing the development of systems and
processes that will improve the client experience and lessen service fragmentation;
and a third approach emphasizes bringing together different sectors such as
education, mental health, and juvenile justice.
Department should take steps to ensure service
integration efforts are sustainable (see pages 7 through
18)
The Department’s first steps to implement its current service integration initiative
appear to be in keeping with recommended practices drawn from studies of such
efforts. Department management have expressed their commitment to service
integration and taken steps to coordinate planning so they can communicate a
consistent message to staff. Management has also participated in planning activities
related to service integration that focused on nationally recognized programs, and
started to look at system-oriented issues, such as funding mechanisms and
information systems, that will support its service integration efforts. At the same time,
the Department has also implemented several local service-oriented efforts that
emphasize developing systems and processes that will improve the client experience
and reduce service fragmentation. The Department’s effort will eventually have to
address a number of staffing-related issues such as hiring staff with the necessary
qualifications and providing training. Finally, the Department is working to improve
communication and collaboration with other governmental and nongovernmental
organizations.
To help ensure it meets its service integration goals and can sustain integration into
the future, the Department should learn from its own previous efforts, establish
comprehensive outcome measures, and evaluate outcomes of its current initiative.
Although some past efforts were evaluated, the Department has not systematically
assessed lessons learned from previous integration efforts that did not continue past
their pilot stage, such as a federally supported Community Services Integration
Project (CSIP) that operated in Flagstaff the 1980s, and an Integrated Service Office
(ISO) pilot project that operated in west Phoenix in the 1990s. The ISO pilot project
was not evaluated after it ended, so no lessons learned or explanations for
termination were documented.
In contrast to previous initiatives, the Department regards its current initiative as a
change in the way it does business, not a pilot program, and it has developed
State of Arizona
page ii
guiding principles that include evaluating services for outcomes. However, to help
ensure its service integration efforts succeed and are sustainable in the future, the
Department should identify and make plans to overcome the barriers to success
encountered by past efforts. In addition, it should continue to share experiences and
ideas from local office initiatives with other local offices, to facilitate their development
of successful service integration initiatives, and identify measurable outcomes,
assess the implications of relying on its current measures, and evaluate the success
of its service integration efforts.
Office of the Auditor General
page iii
State of Arizona
page iv
Office of the Auditor General
TABLE OF CONTENTS
concluded
1
7
7
12
16
18
Introduction & Background
Finding 1: Department should take steps to ensure
service integration efforts are sustainable
Management’s initial efforts appear on track
Department has taken steps to coordinate services and
partner in the community
Service integration efforts must be evaluated
Recommendations
Agency Response:
page v
State of Arizona
page vi
The Office of the Auditor General has conducted a performance audit of the Arizona
Department of Economic Security’s (Department) service integration initiative
pursuant to a November 20, 2002, resolution of the Joint Legislative Audit
Committee. The service integration initiative is a major attempt to restructure the
Department’s approach for delivering services. Its intent is to improve outcomes for
families served and maximize services provided with the resources available.
This audit was conducted as part of the sunset review process prescribed in Arizona
Revised Statutes §41-2951 et seq and is the fourth in a series of six reports on the
Department of Economic Security. The three reports already issued have examined
the Department’s welfare programs (Auditor General Report No. 04-02), the
unemployment insurance program (Auditor General Report No. 05-01), and
information security (Auditor General Report No. 05-04). Subsequent reports will
review the Division of Developmental Disabilities and analyze the Department based
on the 12 statutory sunset factors.
Department vision, mission, and guiding principles
In 2004, department management issued a new statement of the Department’s
vision, mission, and guiding principles in its strategic plan (see text box on page 2).
To achieve its vision of safe and secure children and families, the Department
identified: 1) effective integration of systems of care, 2) service coordination across
systems, and 3) partnership with communities, among several other guiding
principles. These ideas accord with service integration literature, which states that a
program needs a clear mission with specific goals to integrate services successfully.
The Department had already begun moving forward with actions designed to
implement a new service delivery system that would incorporate these three
principles before it officially adopted its new statement. Specifically, it started to
implement service delivery changes in one of its Tucson field offices in December
2003, which are still under way. According to research literature, service integration is
an ongoing process, which department officials also believe.
Office of the Auditor General
INTRODUCTION
& BACKGROUND
page 1
State of Arizona
page 2
Vision
Every child, adult and family in the State of Arizona will be safe and economically secure.
Mission
The Arizona Department of Economic Security promotes the safety, well-being, and self-sufficiency
of children, adults and families.
Guiding Principles
Systems of Care must:
􀁺􇩂 Be customer- and family-driven
􀁺􇩂 Be effectively integrated
􀁺􇩐 Protect the rights of families and individuals
􀁺􇩁 Allow smooth transition between programs
􀁺􇩂 Build community capacity to service families and individuals
􀁺􇩅 Emphasize prevention and early intervention
􀁺􇩒 Respect customers, partners and fellow employees
Services must:
􀁺􇩂 Be evaluated for outcomes
􀁺􇩂 Be coordinated across systems
􀁺􇩂 Be personalized to meet the needs of families and individuals
􀁺􇩂 Be accessible, accountable and comprehensive
􀁺􇩂 Be culturally and linguistically appropriate and respectful
􀁺􇩂 Be strength-based and delivered in the least intrusive manner
Leaders must:
􀁺􇩖 Value our employees
􀁺􇩌 Lead by example
􀁺􇩐 Partner with communities
􀁺􇩂 Be inclusive in decision-making
􀁺􇩅 Ensure staff are trained and supported to do their jobs
Source: Arizona Department of Economic Security, Strategic Plan for State Fiscal Years 2006-2010. (emphasis added)
Department structure and service delivery
The Department has six divisions that provide many different services to children,
adults, and families with needs related to a wide range of factors such as aging,
income, unemployment, and disability:
􀁺􇩁 Aging and Community Services—administers a variety of programs that serve
at-risk and older adults, victims of domestic violence, refugees, the homeless,
and the hungry. The program also provides temporary financial assistance in
emergencies.
􀁺􇨠 Benefits and Medical Eligibility—provides welfare services such as food stamps
and cash assistance. It oversees the State’s Temporary Assistance for Needy
Families (TANF) program, and determines eligibility for medical assistance and
disability services.
􀁺􇨠 Child Support Enforcement—enforces child support obligations and medical
support through various administrative and judicial means, including locating
absent parents and establishing paternity.
􀁺􇨠 Children, Youth and Families—manages Child Protective Services (CPS), which
receives, screens, and investigates reports of alleged child abuse and neglect.
It also provides centralized administrative support services for adoption
programs.
􀁺􇨠 Developmental Disabilities—administers and manages the various programs,
services, and supports for Arizona residents who have been diagnosed with
autism, cerebral palsy, epilepsy, or mental retardation and who meet certain
eligibility requirements.
􀁺􇨠 Employment and Rehabilitation Services—administers a variety of work-related
programs that provide counseling, education, training, rehabilitation, job
placement, and recruiting. It certifies small family childcare homes and provides
childcare assistance to eligible families. Finally, it collects unemployment taxes
from employers and pays unemployment insurance benefits to eligible
individuals.
Historically, government agencies such as the Department that administer federal
and state human services programs have administered services in a “siloed”
manner. The Department has nearly 250 office locations throughout the State. In
many Arizona cities, the divisions have offices that are geographically separated from
each other, so that persons who need multiple services must visit several offices. For
example, in Prescott and Prescott Valley, there are nine different programs working
out of nine separate locations. Although changes are underway in some field offices
Office of the Auditor General
page 3
where divisions are co-located, historically there has been little or no coordination
between programs administered by different divisions. As a result, with the exception
of some past pilot programs, there has been little opportunity to take a more holistic
approach to learning a client’s particular needs and assessing how best to meet
those needs through the many programs and resources that are available.
In addition to its divisions that provide services to the public, the Department has two
divisions—the Division of Technology Services and the Division of Business and
Finance—that provide administrative support to the Department. Finally, the
Department has a Division of Employee Services and Support with responsibilities for
a variety of functions including employee training, special investigations, group home
licensing, and administrative hearings for individuals wishing to appeal department
decisions.
Service integration
Although no widely accepted definition of service integration exists, the idea of
integrating services has been recommended for many years. In the early 1970s, in
response to the proliferation of overlapping and conflicting federal programs that
were developed in the 1960s, policy-makers at both the federal and state levels
began to implement reforms to reduce program fragmentation at the federal, state,
and local levels. In the spirit of these early national endeavors, the Arizona Legislature
established the Department of Economic Security in 1972. It consolidated six major
public assistance and employment programs into one state agency with the
expectation that this organizational structure would reduce duplication of
administrative efforts, services, and expenditures. Reorganizing systems to improve
operational efficiencies does not guarantee a more coordinated, integrated manner
of delivering services.1 Arizona is no exception to this research finding. Even though
it has attempted some service integration pilots in the past, and made organizational
changes during its more than 30 years of existence, department officials nonetheless
still characterize the state of its current service delivery system as “siloed.”
The Department’s current service integration initiative follows a national trend.
Collaborative efforts, such as service integration, have again come to enjoy broad
acceptance in political and professional circles for addressing a variety of problems
in the human services system. Service integration is not a new trend, but Congress
re-energized the idea in 1996 when it passed the Personal Responsibility and Work
Opportunity Reconciliation Act, which is more commonly called Welfare Reform. The
Act provided funding through Temporary Assistance for Needy Families (TANF) block
grants that gave states more flexibility, and required nearly all recipients to participate
in work activities. The increased flexibility led many states to examine the links
between their cash assistance and job training and placement programs through the
1 Pindux, Nancy, Robin Koralek, Karin Martinson, and John Trutko. Coordination and Integration of Welfare and Workforce
Development Systems. Washington, D.C.: U.S. Dept. of Health and Human Services, March 2000.
State of Arizona
page 4
Service integration—
According to the Department,
service integration is a
service delivery model that
helps programs meet
families’ needs through a
more holistic, inclusive, and
strengths-based approach,
focusing on both
coordination of department
programs and on
strengthening relationships
with community partners.
Jobs program.1 (For additional information on Arizona’s welfare reform activities, see
Auditor General Report No. 04-02).
Since there is no widely accepted definition of service integration, this report follows
the Department’s approach, and defines “service integration” as a service delivery
model that helps programs meet families’ needs through a more holistic, inclusive
and strengths-based approach, focusing on both coordination of department
programs and on strengthening relationships with community partners. Although
definitions vary, the research literature tends to characterize service integration efforts
as system, service, or community-oriented. System-oriented efforts emphasize
organizational reform, while service-oriented efforts stress developing systems and
processes that will improve the client experience and lessen service fragmentation,
and community-oriented efforts emphasize bringing together different sectors such
as education, mental health, and juvenile justice. Field research completed by the
Rockefeller Institute in 2002 found that the most comprehensive examples of service
integration occurred in locations where both system and service strategies were
implemented.2 Some of the Department’s activities could be characterized as
system, service, or community-oriented activities.
Scope and methodology
This audit reviews the Department’s efforts thus far in implementing its service
integration initiative. Where information was available from experts or from studies of
other, similar efforts, the audit compares the Department’s approach with the
recommendations from these sources. The audit also provides recommendations for
helping to ensure that the Department can sustain its service integration initiative into
the future.
Auditors used several methods to review the issues addressed in this audit. To
develop the finding, auditors reviewed the Department’s relevant statutes and rules.
Auditors also reviewed annual reports (2001-2003), strategic plans (2004-2010),
welfare reform reports (2003), a grant application to attend a National Governor’s
Association’s (NGA) policy academy, and a 2004 final report to NGA. Auditors
interviewed department management and staff, a former department executive,
faculty in Arizona State University’s College of Public Programs, a nationally
recognized expert on service integration, and the Governor’s policy advisor, who was
involved with the NGA grant and the Governor’s Efficiency Review. Auditors also
reviewed various presentations by outside organizations, including:
􀁺􇩍 Maximus, a private firm that conducted an organizational review of the
Department;
1 Nagle, Ami. Service Integration: An Overview of Efforts and Issues in the Field. Grantmakers Income Security Taskforce,
June 2003.
2 Ragan, Mark. Building Better Human Service Systems: Integrating Services for Income-Support and Related Programs.
Albany, New York: The Nelson A. Rockefeller Institute of Government, June 2003.
Office of the Auditor General
page 5
􀁺􇨠 Merced County’s (California) human services agency;
􀁺􇨠 The Annie E. Casey Foundation; and
􀁺􇨠 The Virginia G. Piper Charitable Trust
Finally, auditors reviewed case studies and evaluations regarding other service
integration efforts and literature on the theory and practice of integrating services in
human services agencies.
To develop the introduction and background section, auditors reviewed literature on
the history of service integration, interviewed current and past department
management and staff, and compiled unaudited information from state and federal
laws and regulations, department reports, federal reports, and other information
provided by the Department.
The information reported in both the introduction and the finding relies primarily on
interview evidence and self-reported agency information. Throughout the audit, audit
staff made a concerted effort to interview the executive, middle-management, and
field office staff that the Department had identified as key contacts or participants in
the service integration activities that this report discusses. However, documentary
evidence was unavailable to corroborate much of the information that key
department management and staff reported.
The audit was conducted in accordance with government auditing standards.
The Auditor General and staff express appreciation to the director of the Department
of Economic Security and his staff for their cooperation and assistance throughout
this audit.
State of Arizona
page 6
Department should take steps to ensure service
integration efforts are sustainable
The Department’s first steps at implementing its service integration initiative appear
to be in keeping with recommended practices drawn from studies of such efforts, but
as it continues to implement the initiative, the Department needs to identify
measurable outcomes and evaluate the success of its service integration efforts.
Positive steps under way include strong support from department management,
communicating a consistent message to all staff, and planning efforts toward
resolving potential problems with funding “silos.” The Department has also
implemented several local service-oriented efforts that emphasize developing
systems and processes that will improve the client experience and alleviate service
fragmentation. However, it still needs to ensure its efforts are sustainable, and it
needs to establish, measure, and document outcomes to determine whether its
efforts are achieving the stated goals.1
Management’s initial efforts appear on track
So far, the Department’s efforts appear to mirror efforts in other states and reflect an
understanding of the key factors for success. The Department is addressing many
issues raised in the literature that have been identified as potential barriers to
success; for example, adequate vision, leadership, administrative support, and
planning, but the agency is only at the very beginning stages in developing specific
strategies to address these and other issues. Implementing large-scale service
integration in an umbrella agency such as the Department requires clear support
from senior management and central planning. Further, integrating services within
such an agency requires building appropriate managerial or administrative
connections.. For example, administrative support, planning, funding, information-
1 The information reported in this finding relies primarily on interview evidence and self-reported agency information. To
develop this finding, auditors interviewed key executive, middle-management, and field office staff that the Department
had identified as important contacts or participants in its current service integration activities. However, documentary
evidence was unavailable to corroborate much of the information that key department management and staff reported.
Office of the Auditor General
FINDING 1
page 7
sharing strategies, and personnel are areas that require organizational initiative.1 The
Department has taken several steps toward these organizational initiatives. Executive
staff and managers are working to ensure that all current and new employees are
learning about service integration, and the Department has established teams to aid
in overseeing and supporting service integration efforts. Some other aspects of
administrative support, such as information systems and staffing, are still in very early
stages of development, and more time will be needed before they can be assessed.
Early steps indicate management support—The Department’s initial
activities and planning indicate top leadership is supportive of change. Lack of
support from leadership can severely threaten the viability of integrated services.2 In
contrast, strong leaders who are willing to push for reform, persuade others to join
the cause, and stick with it until the system changes may be the single most
important factor affecting an integration effort’s outcome.3
Department executives and other managers have expressed their commitment to
service integration, and are taking steps to support and coordinate the initiative’s
goals, so they can communicate a consistent message and achieve the
Department’s vision (see text box). In addition, the Department’s executives and
managers have participated in several activities related to service integration that
focused on nationally recognized programs. Working with the Governor’s Office, the
Department obtained a grant from the National Governors Association to attend two
policy academies on cross-system innovation in April and September 2004. At these
sessions, the representatives developed three specific goals for the Department to
focus on immediately:
1) Reducing the number of children in foster care
2) Reducing the number of children in congregate care 4
3) Reducing growth in the TANF caseload
These goals are consistent with the director’s belief that human services programs
are prevention programs. Before coming to Arizona, the director pioneered this idea
in his work in El Paso County, Colorado, and Michigan.
Lack of support from
leadership can severely
threaten the viability of
integrated services.
1 Gans, Sheldon P., and Gerald T. Horton. Integration of Human Services: The State and Municipal Levels. Praeger
Publishers, 1975.; Polend, Nancy L. Making Service Integration a Reality. Policy and Practice, September 2002.
2 Agranoff, Robert. Human Services Integration: Past and Present Challenges in Public Administration. Public
Administration Review, Nov/Dec 1991; Gans, Sheldon P. and Gerald T. Horton. Integration of Human Services: The State
and Municipal Levels. New York: Praeger Publishers, 1975.
3 Ragen, Mark. Building Better Human Service Systems: Integrating Services in Income-Support Related Programs. Albany,
New York: The Nelson A. Rockefeller Institute of Government, June 2003.
4 Institutional care in facilities such as group homes, correctional institutions, shelters, and hospitals.
State of Arizona
page 8
In the past, lack of clear support may have
contributed to the termination of a previous
department effort to achieve service
integration. In 1985, Arizona participated in a
federal pilot program designed to help
families achieve self-sufficiency through
better employment opportunities. The
Community Services Integration Project
(CSIP) ran in Flagstaff for nearly 2 years
(1987-1989), and its evaluation concluded
that the pilot project reduced duplication and
gaps in services. However, the evaluation
report also indicated that the project’s key
supporters, including the Department’s
director, were gone by the time the pilot
program concluded. Once the pilot
concluded, federal funding was not provided
to expand the program. Without support, a
new funding source was not identified.
Ways to deal with funding “silos” are
being reviewed—Funding mechanisms,
which are set up largely on a program-by-program
basis, represent a potential source of
problems for service integration efforts, and the Department is working on ways to
monitor and address this matter. Much of the Department’s funding comes from
federal programs that support specialized activities and narrowly defined target
populations. As a result, the Department—like its counterparts in other states—has
developed specialized organizational structures and processes to implement the
federal programs. These funding “silos” have constrained and hampered integration
since the earliest efforts, because every program has different eligibility and reporting
requirements.
Although the Department cannot change federal
requirements, managers in its Division of Business and
Finance (DBF) have expressed their intention to resolve
funding-related problems as they arise. In addition, the
Department has established an administrative support
team for the service integration initiative. The team is
developing a service integration tool kit (see text box) to
serve as a resource for all field offices wanting to better
integrate services. The tool kit is still in draft form, but the
outline indicates that it will include cost allocation
models for sharing costs.
Office of the Auditor General
page 9
Management’s Support
􀁺􇩁 A service integration steering committee, which includes the
director and his deputy directors and assistant directors,
meets biweekly
􀁺􇩁 A designated employee has the sole responsibility of
facilitating the service integration initiative
􀁺􇨠 A core service integration team will oversee the service
integration efforts and report to the steering committee
􀁺􇩁 An administrative support team performs trouble-shooting to
help local programs with barriers to integration
Efforts To Communicate a Clear, Consistent
Message to Staff
􀁺􇩄 Disseminate information and obtain feedback on proposed
service integration strategies and methodologies at regularly
scheduled events
􀁺􇩄 Developed a video presentation to show to every current and
new employee
􀁺􇩐 Published a wallet-size tri-fold for its staff, which states its
vision, mission, and guiding principles
Service Integration Tool Kit—The tool kit will
provide local offices with a structured, but not
prescribed, starting point for their service
integration efforts. It will consist of a resource
guide and a workbook. The guide will include items
such as a phone list of important contacts, sample
floor plans, and facilities checklists. It will also
include information on overcoming administrative
barriers, cost allocation, and involving the
community. The workbook will offer ideas on how
to proceed and best practices to consider in
undertaking an integration effort.
These steps appear consistent with federal efforts to provide a somewhat greater
degree of funding flexibility. The U.S. government recognizes the limitations created
by its funding requirements and has taken some steps to give states more flexibility,
such as providing some funding in the form of block grants and allowing states to
apply for waivers from some requirements.1 In addition, one federal funding source—
the TANF Block Grant—actually encourages service integration. Under the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (welfare reform),
Congress set requirements for cash assistance recipients to participate in work
activities. Implementing this requirement requires coordination, if not integration,
between cash assistance, Jobs, and childcare programs.
Preliminary work under way to address substantial information-sharing
issues—The Department’s efforts regarding information-sharing are in
the early stages, but so far they reflect an awareness of this area’s importance.
Agencies have recognized the importance of information sharing since the earliest
efforts to integrate services.2 However, issues of confidentiality, development costs,
and program fragmentation often limit the amount of shared information. For
example, a study by the Rockefeller Institute of Government reports that by 1998, the
Nebraska Department of Health and Human Services spent over $58 million on an
integrated information system, and California’s and Texas’ human services agencies
have each spent over $250 million developing their systems.3,4 In addition to the high
costs, these systems can take years to implement. For example, Nebraska required
more than 7 years to develop its new shared-information system, Texas projects it will
need 7 years, and California projects it will require approximately 10 years for its
project.
The Department is taking steps to improve its information systems’ ability to support
service integration. The Department’s current information systems are based upon
1970s and 1980s mainframe technology. Much of the Department’s human services
information is collected and stored multiple times on the mainframe computer
because each program’s information system operates independently. These
systems create an inflexible environment that does not easily meet the Department’s
future needs. The Department has identified a long-term goal to replace its
mainframe technology with a Web-based system that includes integrated
1 Parrott, Sharon, and Stacy Dean. Aligning Policies and Procedures in Benefit Programs: an Overview of the Opportunities
and Challenges Under Current Federal Laws and Regulations. Center on Budget and Policy Priorities, January 2004.
2 HEW Task Force, 1972 U.S. Dept. of Health, Education, and Welfare: Social and Rehabilitation Service. Integration of
Human Services in HEW: An Evaluation of Services Integration Projects (Volume 1). 1976.
3 Ragan, Mark. Service Integration Supported by Information Technology—the N-FOCUS System in Nebraska. Albany, NY:
The Rockefeller Institute of Government, April 2002.
4 California’s Health and Human Services Agency has spent the money on its Statewide Automated Welfare System
(SAWS). Consortium IV, which includes San Bernardino, Stanislaus, Riverside, and Merced Counties, uses SAWS. Texas’
Health and Human Services Commission spent its money on the Texas Integrated Eligibility Redesign System.
State of Arizona
page 10
The Department’s
current information
systems are based
upon 1970s and 1980s
mainframe technology.
information. Meanwhile, it is working on two
interim solutions: a decision support
system and a central information file that will
enable staff to obtain client information from
multiple systems that still reside separately
on the mainframe. However, department
officials also report that they plan to move
forward with their current service integration
efforts despite lacking this technology.
Technology and IT systems offer both
promise and difficulty with regard to service
integration. For example, technology could
support efforts to implement “one-worker”
staff models that attempt to use one staff
person to deliver services to clients who are
involved in a variety of programs. According
to several department staff, during the early
2000s, the Department discussed
establishing one position to handle TANF,
Jobs program, and Child Care
Administration assessments as part of its
ongoing welfare reform activities. However,
department staff report that the idea was
never implemented. One department
official indicated that a lack of an adequate
information system to support such a
worker contributed to shelving the idea.
Although an integrated IT system might
have helped the Department succeed in
implementing a one-worker concept to
handle assessments, such systems can take years to develop and require
participation by all users in the design and development. They also are inherently
difficult to build because of concerns over sharing sensitive information. Finally, other
requirements that staff must consider include developing policies that address
security and confidentiality across fragmented programs, assuming shared
responsibility for system integrity, and developing a system that reflects client needs
as well as organizational needs.
Office of the Auditor General
page 11
Information-Sharing Efforts
Proposed Web-based system to replace mainframe
􀁺􇩉 Initially focus on three areas: the Jobs Administration, the Child
Care Administration, and welfare programs such as Temporary
Assistance for Needy Families (TANF)
􀁺􇩉 Integrate and automate all of these programs’ business
functions, including intake, registration, eligibility determination,
and case management
􀁺􇩁 Add other programs in phases
􀁺􇩐 Projected to cost nearly $76 million and take 5 years to
implement
Decision Support System
􀁺􇩅 Enable staff to see data from multiple information systems
􀁺􇩁 An after-the-fact reporting system
􀁺􇩗 Will not integrate day-to-day processes such as intake and
eligibility determination
􀁺􇩐 Project will be piloted by the Department starting in June or July
2005
Central Information File
􀁺􇨠 Enable staff to access limited information about individuals in all
the Department’s programs
􀁺􇩓 System will display possible matches and the employee will be
able to decide if the matches are the same person
􀁺􇩁 Accessible to users of desktop computers as well as mainframe
users. Phase one should be completed in October 2005.
Staffing will be particularly challenging—The Department’s
effort will eventually have to address a number of staffing-related
issues, and thus far in the process, the Department has not yet begun
to address these issues. Efforts to expand services, improve service
quality, and minimize cost rely on appropriately using staff.1 Hiring staff
with the necessary qualifications, providing necessary training, and
addressing issues such as salary differences between programs are all
essential to success. For example, El Paso County, Colorado, found it
needed to replace many staff who transferred to different jobs rather
than learn the new skills and attitudes required by its new integrated
service delivery model.2
The Department, like many other state agencies, has difficulty attracting
and retaining qualified employees. According to the Department’s Personnel Office,
the Department experiences high turnover among eligibility interviewers and child
protective services caseworkers. Several divisions also have a lot of vacancies, such
as Child Support Enforcement and Developmental Disabilities. As it moves forward
with service integration, the Department can choose from numerous staffing
mechanisms, including joint use of staff, staff transfers, staff out-stationing, or co-location
(see text box).3 In addition, it can consider several other actions to enhance
further integrated staffing including consolidating administrative personnel, setting
minimum personnel standards at integrated field offices, and developing operating
policies and training requirements at field offices. Staffing considerations will also
need to include such other considerations as the amount of central staffing needed
to support local efforts and the potential effect of staff turnover and caseloads on
staffing models.
Department has taken steps to coordinate services and
partner in the community
In addition to administrative support, the Department is also taking steps both
internally and externally to help develop systems and processes that will improve the
client experience and alleviate service fragmentation. Internally, the steps include
giving local multi-service offices flexibility in deciding how best to serve their clients,
as well as taking steps to provide support and direction from the department level.
1 Gans, Sheldon P. and Gerald T. Horton. Integration of Human Services: The State and Municipal Levels. New York:
Praeger Publishers, 1975; Nittoli, Janice. The Unsolved Challenge of System Reform: The Quality of Frontline Human
Services Workers. Annie E. Casey Foundation, 2003; U.S. Dept. of Health, Education, and Welfare: Social and
Rehabilitation Service. Integration of Human Services in HEW: An Evaluation of Services Integration Projects (Volume 1).
Washington, D.C.: U.S. Dept. of Health, Education, and Welfare, 1976.
2 Hutson, Rutledge Q. A Vision for Eliminating Poverty and Family Violence: Transforming Child Welfare and TANF in El Paso
County, Colorado. Center for Law and Social Policy, January 2003.
3 Gans, Sheldon P., and Gerald T. Horton. Integration of Human Services: The State and Municipal Levels. Praeger
Publishers, 1975.
State of Arizona
page 12
Joint use of staff—two programs use the
same staff to deliver different services
Staff transfers—staff shifts to meet clients’
needs
Staff out-stationing—service providers
station staff where needed
Co-location—staff from multiple programs
share the same office or building
Externally, the Department is working to improve collaboration with other
organizations that also provide services to clients—an important step, according to
research conducted on other service integration efforts.
Internal steps allow flexibility as well as providing support and
direction—Internally, the Department has implemented several efforts to improve
service coordination, client satisfaction, and self-sufficiency. One encourages field
offices that house multiple programs to improve service coordination on their own,
while others provide support to field offices and create new multi-disciplinary teams
to target at-risk families. These efforts appear to be consistent with the Department’s
guiding principles, which state that systems of care must be customer- and family-friendly
and effectively integrated, and that services should be coordinated across
systems and personalized to meet the needs of families and individuals. Specifically:
􀁺􇩅 Encouraging coordination in multi-service offices—In 2003, the Department
started to encourage several field offices that housed multiple department
programs to take the initiative to improve service coordination within their
offices.1 Research literature supports service delivery decisions being made at
the local level, closest to those who receive the services.2 The literature identifies
several different strategies for improving client satisfaction and service delivery.
Two field offices with multiple programs—Tucson’s Irvington office and
Phoenix’s South Mountain office—responded to executive management’s
directive to improve service delivery. Each office already had co-located
programs, such as TANF (cash benefits) and Jobs (employment) programs, but
neither office had good mechanisms in place to encourage integration and
referrals. The Department did not mandate how these offices should improve
service integration, but instead encouraged the offices to determine what would
work best for them and the local community they served. The Department’s new
administrative support group was formed in part to assist the Irvington and
South Mountain field offices with their efforts to improve service delivery by
solving administrative problems.
The Irvington office implemented its initial changes in December 2003; the South
Mountain office in April 2004. Both offices started by integrating their TANF and
Jobs programs. The Irvington office established a new “customer service
representative” position to work with customers for all programs. This position is
designed to assess a customer’s needs and to direct them to the appropriate
services.
1 The Department has several multi-service facilities around the State to encourage “one-stop” access to services. This is
consistent with a series of case studies by the Rockefeller Institute, which reported that most sites they reviewed used
one-stop centers. According to the Rockefeller report, managers in two Wisconsin counties mentioned as good examples
of service integration stated that one-stop offices are critical to their efforts to provide comprehensive services.
2 Waldfogel, Jane. The New Wave of Service Integration. Social Science Review, September 1997.
Office of the Auditor General
page 13
The South Mountain office followed Irvington’s approach but made changes to
meet its own needs. For example, South Mountain staff asked for a child support
enforcement officer to be located on-site for more direct access by TANF
applicants.1 The South Mountain office is now implementing the second phase
of its integration effort, which involves greater coordination between benefits
programs and Child Protective Services.2
These integrated offices should continue to share experiences and ideas with
other local offices to facilitate their development of successful service integration
initiatives and identify measurable outcomes. Since the changes at Irvington and
South Mountain, several other multiple-service offices in Tucson have also
reorganized their offices. Others have also started looking at reorganizing their
offices, including offices in Casa Grande, Yuma, Show Low, and an additional
office in Tucson.
􀁺􇩆 Forming multi-disciplinary “Family Connections Teams” to target at-risk
families—In addition to allowing innovation at co-located field offices, the
Department has also started to form teams, known as Family Connections
Teams, that will focus on families at risk of entering the child welfare system and
who might benefit from intensive services. The teams are made up of staff from
Child Protective Services, the Family Assistance Administration, and the Jobs
program. The Department established two teams in January 2005, one in
Phoenix and one in Tucson. The director hopes to have ten teams in place by
the end of 2005. The Department assigned the teams to the Division of Aging
and Community Services, although actual team members came from three
other program divisions.3
Both teams have identified their own priority populations. Both teams decided
to focus on Kinship Care families because these families, usually grandparents
raising their grandchild, can be under a lot of stress and therefore at risk.
Additionally, the Phoenix team has elected to focus on families involved in a
dependency court and domestic violence shelters, while the Tucson team is
starting a partnership with schools in specific zip codes. If the teams determine
that a family might benefit from services, they will be authorized to make an
immediate benefit determination, in contrast to the Department’s normal 30- to
45-day approval process. Both teams adopted two goals in addition to the
Department’s three goals: 1) reduce recidivism and 2) increase the client’s self-
1 TANF clients who are custodial parents must cooperate with efforts to locate absent parents and establish and enforce
child support orders.
2 The office plans to have Child Protective Services (CPS) caseworkers provide the office’s customer service representative
with a list of all persons against whom an allegation of abuse or neglect has been made. The customer service
representative will in turn notify CPS if any person on the list has other department connections. CPS investigators can
then use this information when visiting the client. Historically, this information has not been shared.
3 The Division of Children, Youth and Families (DCYF); the Division of Benefits and Medical Eligibility (DBME); and the
Division of Employment and Rehabilitation Services (DERS).
State of Arizona
page 14
Kinship Care—Kinship care
involves the parenting of a
child by a relative when the
relative takes on the
responsibility without court or
child welfare agency
involvement.
Recidivism—A tendency to
slip back into a previous
behavior pattern.
sufficiency. The teams plan to use an evaluation instrument that has been
independently tested for validity and reliability to test client self-sufficiency.
Department is collaborating with others—The Department is also working to
improve collaboration with other organizations, a step that is consistent with research
recommendations. The Department recognizes that solutions to Arizona’s human
services problem extend beyond the Department’s boundaries. The Department’s
guiding principles state that systems to serve families and individuals must build
community capacity, and that leaders must partner with communities. This
recognition is in line with research, such as a 12-state review of service integration
programs that identified a high level of cooperation and collaboration between
government agencies and community organizations as a critical element for
successful implementation.1 The following are examples of the Department’s efforts
to work within the communities:
􀁺􇩓 Seeking community input—The Department seeks community input through
several key community groups. One is the Economic Security Advisory Council,
which was established by statute to enable community representatives to advise
the Department. Others are Community Network Teams (CNTs), which were
established by the Governor’s 2003 Action Plan for Reform of Arizona’s Child
Protection System to help foster community involvement in improving the child
welfare system in Arizona. State-wide, there are about 18 CNTs, which hold
regular meetings to provide input to the Department on how the State and
communities can better serve their customers by working together. Members
include representatives from state agencies, community providers, families,
educators, tribes, courts, victim advocates, faith-based and philanthropic
organizations, and businesses. The Department has used these gatherings to
describe service integration, the potential advantages for the people served,
and progress on implementation, and to obtain feedback on how the
Department might better integrate services within each community. For
example, in July 2004, Pima County’s CNT issued a report that included
integrated service delivery recommendations.
􀁺􇩁 Addressing statutory barriers to co-location—The Department obtained
legislation in the 2005 legislative session to increase its ability to co-locate with
other nondepartment programs.2 Prior to passage of this legislation, the
Department lacked the authority to lease unoccupied space in department
buildings to other entities. For example, the Department could not sublease
space to other agencies or private providers who contract with the Department
to provide services. Instead, the Department used co-location agreements and
intergovernmental agency agreements for sharing facilities. According to a
department report, the new law provides more flexibility to respond to changing
circumstances.
1 Ragan, Mark. Building Better Human Service Systems: Integrating Services for Income-Support and Related Programs.
Albany, New York: The Nelson A. Rockefeller Institute of Government, June 2003.
2 Laws 2005, Chapter 224, 47th Legislature, First Regular Session.
Office of the Auditor General
page 15
Solutions to Arizona’s
human services
problem extend
beyond the
Department’s
boundaries.
􀁺􇩅 Enhancing homeless outreach—The Family Assistance Administration (FAA)
and the Division of Child Support Enforcement (DCSE) are piloting a project at
six homeless shelters. The initiative involves having an FAA caseworker go to the
shelters to help homeless TANF applicants and recipients with tasks such as
filling out department documents, completing paternity affidavits, and obtaining
birth certificates. DCSE plans to cross-train the FAA caseworker so she can also
assist its homeless clients. Eventually, the Department would like to train shelter
staff to develop and complete a single employment plan that complies with both
the Department’s Jobs program requirements and the homeless shelter’s
requirements. Although homeless shelters already require their clients to have
an employment plan, their plans are not approved by the Department.
Developing one employment plan would eliminate the need for clients to
manage two employment plans. In addition to these efforts, the Department is
involved with other Maricopa County homeless population service providers,
such as the Day Resource Center. This Center uses an integrated services
model to target chronically homeless individuals. The model is based upon
other models used across the country in cities such as Philadelphia. The Center
will move to a new Human Services Campus that Maricopa County is
constructing in downtown Phoenix, probably later this year.
Service integration efforts must be evaluated
To help ensure it meets its service integration goals and can sustain integration into
the future, the Department should learn from its own previous efforts, establish
comprehensive outcome measures, and evaluate outcomes of its current initiative.
Previous service integration efforts were not always evaluated or continued past the
pilot stage. The Department regards its current initiative as a change in the way it
does business, not a pilot program, and it has developed guiding principles that
include evaluating services for outcomes. However, it has not yet developed
comprehensive measures for evaluating outcomes.
Department should learn lessons from past service integration
efforts—The Department has attempted service integration in the past. For
example, during the 1980s and 1990s, the Department piloted a Community Services
Integration Project (CSIP) in Flagstaff and an Integrated Service Office pilot project in
west Phoenix. In addition, Arizona’s welfare reform program, EMPOWER (Employing
and Moving People Off Welfare and Encouraging Responsibility), and the Arizona
Works pilot program that privatized employment-related services for welfare
recipients linked employment and childcare programs to cash assistance.
Department officials report that the current service integration initiative is not a pilot
but a new standard, department-wide business practice. This new practice reflects
the Department’s new vision, mission, and guiding principles, which state, in part,
State of Arizona
page 16
that systems of care must be effectively integrated and include partnership with
communities. The guiding principles also state that services must be evaluated for
outcomes. This principle is consistent with research confirming that evaluating the
impact of service integration efforts is an important administrative responsibility
because the results can help management respond to technical and logistical
problems, make recommendations for program modifications, and assess how and
whether to expand programs.1
Because evaluating outcomes is one of its guiding principles, the Department should
examine past efforts to identify barriers that hampered or led to terminating the
efforts, and apply any lessons learned to its current initiative. Although some past
efforts were evaluated, the Department has not systematically assessed lessons
learned from previous integration efforts. For example, the CSIP program evaluation,
which was conducted by a contractor for the U.S. Department of Health and Human
Services as part of a multi-state evaluation project, identified possible reasons for the
pilot’s end (see page 9). In contrast, the ISO pilot project was not evaluated after the
program ended, so no lessons learned or explanations for termination were
documented. The ISO project, which operated from 1994 through 1998, used
assessment specialists with multi-program expertise and a single application form for
eligibility assessment and case management duties for several programs.2 Months
after the ISO ceased, a department contractor evaluated the office and included
observations on physical reorganization, interagency communication, and
administration, but described an office without an assessment specialist and a single
application process.
Department should evaluate outcomes—In addition to making sure it
understands lessons learned from past efforts, the Department also needs to
establish formal mechanisms to evaluate outcomes for its current service integration
initiatives. Because a well-designed evaluation plan is such an important component
of any service integration effort, the Department should ensure that it develops
systematic evaluation activities to ensure that it can learn and apply lessons from its
current efforts.
The Department has established three specific, measurable goals (see page 8). The
Family Connections Teams have expanded upon these goals. In addition, the
Department has identified a validated self-sufficiency assessment tool for measuring
this team’s client outcomes, and is considering using this tool with other clients.
Although the Department has identified a tool and indicators to evaluate client
outcomes, as well as methods to evaluate its own system outcomes for some
specific initiatives, these efforts must be expanded and continued. In addition, it
1 Yessian, Mark R., Ph.D. Learning from Experience: Integrating Human Services. Public Welfare, Summer 1995.
2 Current department staff who worked on the project suggested that it ended mainly due to loss of momentum when
original staff left to pursue other job opportunities and program costs. Former program staff said that program worked
well for a while, but started to break down when original staff were promoted and replaced by new staff who did not have
the same level of buy-in as the original staff.
Office of the Auditor General
page 17
needs to assess the implications of relying on its current measures. For example, one
of its goals is reducing TANF rolls. Without individual level outcome measures such
as improved family functioning, number of successfully completed cases, and
average improvement in length and quality of employment at the
organizational/system level—which is one of the Department’s planned strategies for
achieving a reduction in TANF caseload growth—the TANF reduction goal could
result in unintended consequences for the populations the Department is trying to
serve.
Recommendations
1. To help ensure its service integration efforts succeed and are sustainable in the
future, the Department should:
a. Identify and make plans to overcome the barriers to success encountered
by past efforts.
b. Continue to share experiences and ideas from local office initiatives with
other local offices to facilitate their development of successful service
integration initiatives.
c. Identify measurable outcomes, assess the implications of relying on its
current measures, and evaluate the success of its service integration
efforts.
State of Arizona
page 18
Office of the Auditor General
AGENCY RESPONSE
State of Arizona
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
1717 W. Jefferson • P.O. Box 6123 • Phoenix, AZ 85005
Janet Napolitano
Governor
David A. Berns
Director
Ms. Debra K. Davenport, CPA
Auditor General
Office of the Auditor General
2910 North 44th Street, Suite 410
Phoenix, Arizona 85018
Dear Ms. Davenport:
The purpose of this letter is to forward the Arizona Department of Economic
Security’s written response to the preliminary draft report of the performance
audit of the Department’s Service Integration Initiative.
The Department is pleased with your recognition of our commitment and initial
efforts to implement a new service delivery approach to improve outcomes for
families served. We also appreciate the cooperation of your staff throughout the
performance audit process.
If you have any questions regarding this response, please contact me at (602)
542-5678 or Susan Hallett, Service Integration Project Coordinator at (602) 542-
6017.
Thank you for the opportunity to review the preliminary draft report.
Sincerely,
David A. Berns
Enclosures
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
SUNSET REVIEW ON SERVICE INTEGRATION DRAFT REPORT
RESPONSE TO AUDITOR GENERAL RECOMMENDATIONS
JUNE 30, 2005
Finding 1: Department should take steps to ensure service integration efforts are
sustainable.
The Department concurs with the finding.
Auditor General Recommendations:
a. Identify and make plans to overcome the barriers to success encountered by past
efforts.
The finding of the Auditor General is agreed to and the audit recommendation will be
implemented.
DES Response:
There is a strong core team made up of key individuals from all areas (representing both
staff and management). They are responsible and accountable for identifying tasks and
adhering to timelines. This core team was formed in response to prior experiences
indicating there is a need for increased coordination and communication among
divisions. The group is documenting checkpoints throughout the process to provide the
opportunity to evaluate outcomes, along with identifying and communicating “lessons
learned”. The information will be utilized to implement any needed changes prior to
moving to the next phase. Communication plans are in process that place emphasis on
consistent and timely information being distributed to the Agency.
The Agency has placed a strong focus on ensuring that staff be an integral part of the
process throughout this initiative. They are encouraged to utilize their knowledge and
experience to contribute ideas for change. Focus groups have been, and will continue to
be, utilized for development of new processes. An Intranet site is being implemented that
will provide a mechanism for communicating to staff as well as soliciting ideas and
feedback. In addition, the Department is identifying perceived barriers and developing
solutions to further service integration initiatives.
b. Continue to share experiences and ideas from local office initiatives with other
local offices to facilitate their development of successful service integration
initiatives.
The finding of the Auditor General is agreed to and the audit recommendation will be
implemented.
Arizona Department of Economic Security
Response to Auditor General’s Draft
Page 2
DES Response:
The Agency will continue to investigate and rely on what other States and Agencies have
done successfully. We also rely on bringing in community representatives as part of the
process of identifying needs or procedural changes that will ensure our clients needs are
met most effectively.
As a new process is implemented in a local office, it is evaluated to determine if any
changes or updates are needed. The results are used to communicate and improve the
process prior to incorporating in other offices. An Intranet site is being implemented that
will provide a mechanism for communicating to staff as well as soliciting ideas and
feedback.
c. Identify measurable outcomes, assess the implications of relying on its current
measures, and evaluate the success of its service integration efforts.
The finding of the Auditor General is agreed to and the audit recommendation will be
implemented.
DES Response:
A key element to the success of Service Integration is measuring whether the new process
is working, along with developing new measures where needed. A team has been
established to focus on Performance Management and implement appropriate measures.
A consultant will also be utilized to help us ensure we are focused on the right things.
The data obtained in the process will be analyzed and utilized to identify areas we need
to modify or reevaluate, if necessary, as we progress through the service integration
process. The measurements will also identify successes we can use as a communication
tool and encouragement for Agency staff as we implement changes.
03-05 Department of Economic
Security—Child Protective
Services—Foster Care
Placement Stability and
Foster Parent Communication
03-06 Arizona Board of Appraisal
03-07 Arizona Board for Charter
Schools
03-08 Arizona Department of
Commerce
03-09 Department of Economic
Security—Division of
Children, Youth and Families
Child Protective Services—
Caseloads and Training
04-L1 Letter Report—Arizona Board
of Medical Examiners
04-L2 Letter Report—Gila County
Transportation Excise Tax
04-01 Arizona Tourism and
Sports Authority
04-02 Department of Economic
Security—Welfare Programs
04-03 Behavioral Health Services’
HB2003 Funding for Adults
with Serious Mental Illness
04-04 Department of Emergency and
Military Affairs and State
Emergency Council
04-05 Department of Environmental
Quality—Water Quality Division
04-06 Department of Environmental
Quality—Waste Programs
Division
04-07 Department of Environmental
Quality—Air Quality Division
04-08 Department of Environmental
Quality—Sunset Factors
04-09 Arizona Department of
Transportation, Motor Vehicle
Division— State Revenue
Collection Functions
04-10 Arizona Department of
Transportation, Motor Vehicle
Division—Information Security
and E-government Services
04-11 Arizona Department of
Transportation, Motor Vehicle
Division—Sunset Factors
04-12 Board of Examiners of Nursing
Care Institution Administrators
and Assisted Living Facility
Managers
05-L1 Letter Report—Department
of Health Services—
Ultrasound Reviews
05-01 Department of Economic
Security—Unemployment
Insurance
05-02 Department of Administration—
Financial Services Division
05-03 Government Information
Technology Agency (GITA) &
Information Technology
Authorization Committee (ITAC)
05-04 Department of Economic
Security—Information Security
Performance Audit Division reports issued within the last 24 months
Future Performance Audit Division reports
Department of Revenue—Business Reengineering/Integrated Tax System (BRITS)
Arizona State Retirement System