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Introduction to the symposium: nonprofit organizations as key partners in the development, delivery and evaluation of health and human services.

Nonprofit and government agencies in the United States have a long history of working together at the local, state, and federal levels for community awareness and education, information gathering, policy creation, direct service delivery, and performance evaluation, particularly in the health and human services arena. In fact, it is hard to imagine today how our society's health and human service concerns would be met without nonprofit providers. Governments have long utilized and subsidized nonprofit agencies to deliver services (Young, 1999) and, as Smith and Lipsky (1993) emphasize, nonprofit organizations rely on government for financial support. Both government and nonprofit agencies have unique roles to play in this important and mutually beneficial partnership. While there is no "typical" partnership, funding has become a primary aspect of government-nonprofit relations. As such, government grants and contracts accounted for 29.4% of nonprofit revenues in 2005 (Blackwood, Wing, and Pollak, 2008).

Chartered by state level governments and recognized by the U.S. Internal Revenue Service for additional tax exemption/deductibility status, the landscape of nonprofit organizations is diverse ranging from homeless shelters, job training programs, and HIV clinics to museums, civic groups, and professional associations. This diverse set of organizations numbers at almost 2 million tax exempt organizations registered with the IRS (The Urban Institute, 2009), an increase of 27.5% since 1995 (Blackwood, Wing, and Pollak, 2008). What these organizations have in common is an identified public or collective purpose. Individually and as a sector, nonprofit organizations add essential dimensions of responsiveness, expression, and innovation to the implementation of democracy in the United States.

Nonprofit organizations in the area of health and human services (see Table 1) represented 29 percent of the 975,777 public charity nonprofits registered in April 2009 (NCCS, 2009). These numbers do not include the many churches and other faith-based institutions without official nonprofit status who also supply services to a growing population in need.

This symposium focuses on the nonprofit-government partnerships in health and human services. The articles included here cover a range of health and human service policy areas from development disabilities and mental health to geriatric education. They recognize a variety of tools for nurturing and sustaining nonprofit-government partnerships including training centers, fee-for-service arrangements, performance assessment, collaborative activities, and communitywide needs assessment.

In their article, Medicaid Fee for Service Reimbursement and the Delivery of Human Services of Individuals with Developmental Disabilities or Severe Mental Illness: Negotiating Cost, Melissa A. Walker and Jason E. Osterhaus examine how federal, state and local government agencies negotiate cost for the delivery of human services. The article uses the Medicaid funded services to individuals with development disabilities or severe mental illness in Sedgwick County, Kansas, as the focus of study. The data was collected from 30 interviews with executive directors of nonprofit agencies, the directors and key staff of the locally designated community development disability organization and community mental health centers, and state human services officials, agency annual reports and financial statements, and related state expenditure and revenues for development disability and mental health services. The varying perspectives of government and nonprofit agencies in determining funding levels and provision strategies provide insight into how each attempts to manage cost.

Beth Eschenfelder's article Using Community-based Needs Assessments to Strengthen Nonprofit-Government Collaboration and Service Delivery offers a case study of a community needs assessment conducted by the local Salvation Army in Clearwater, Florida. Using a multiple method approach that included a review of existing data, key informant interviews, nonprofit and government service provider focus groups, and client and community surveys, the needs assessment provided a comprehensive look at the health and human services needs of the targeted geographic area. The article details the methods used and importantly the data analysis strategies allowing agency leaders and community stakeholders to better understand existing needs, service gaps, and barriers to access, laying the foundation for comprehensive, community wide planning and coordination.

The article Enhancing Long-Term Care for Older Adults: An Exploration of Interagency Collaboration and Geriatric Education Centers by Channing R. Ford, Jennifer Henderson and Donna Milam Handley examines federally funded geriatric training centers as a mechanism for strengthening the interdisciplinary understanding of health care professionals serving older populations in public and nonprofit organization settings including nursing homes, hospitals, senior services agencies, and ambulatory care centers. In particular, the article studies five centers and their degree of interdisciplinarity and their use of collaboration with local community-based nonprofits and professional associations as well as across the 48 funded centers in the United States. Increased interdisciplinary training is clearly evidenced while also identifying challenges for more comprehensive and useful collaboration including a perception of competition for continued funding and site-specific data security concerns. Recommendations focus on the role of the funding agency in developing performance measures that highlight collaborative activities.

In her article, The Importance of Performance Assessment in Local Government Decisions to Fund Health and Human Services Nonprofit Organizations, Shannon K. Vaughan considers how local governments define nonprofit organization success and considers the type of assessment tools that they find most useful. Using a respondent pool of local government administrators from the Alliance for Innovation, a nonprofit association of more than 300 cities and counties across the United States, a survey finds that clear mission focus and meeting community needs are important to defining nonprofit success for local public administrators regardless of the type of nonprofit. However, understanding the aims of the contracting government is essential for nonprofit agency staff to develop performance assessment measures that are valuable.

The 21st Century has further blurred the lines of the private, nonprofit and public sectors, while also providing evidence of the key role each plays in our complex mixed economy. The goal of this symposium is to continue the dialogue about the purpose, function, and impact of the many health and human services partnerships that include nonprofit and government agencies. While each partnership is unique, the articles presented here discuss critical dimensions important to building reciprocal relationships. As a group, they suggest that the more each partner knows about the other's needs and expectations regarding the collaborative activity, the greater the potential to strengthen and transform government-nonprofit relationships for greater effectiveness in relieving human suffering and addressing critical public problems.


Blackwood, Amy, Kennard T. Wing, and Thomas H. Pollak. 2008. The Nonprofit Sector in Brief: Facts and Figures from the Nonprofit Almanac 2008: Public Charities, Giving, and Volunteering. Washington, D.C.: The Urban Institute.

National Center for Charitable Statistics. 2009. Number of Registered 501(c)(3) Public Charities by NTEE Activity/Purpose (released April 2009). Retrieved November 28, 2009 from overviewsumRpt.php?v=ntee&t=pc&f=0

Smith, S.R., & Lipsky, M. (1993). Nonprofits for hire: The welfare state in the age of contracting. Cambridge, MA: Harvard University Press.

The Urban Institute. 2009. National Center for Charitable Statistics, Business Master File 12/08. Retrieved November 28, 2009 from

Young, Dennis R. 1999. Complementary, Supplementary, or Adversarial? A Theoretical and Historical Examination of Nonprofit-Government Relations in the United States. In Boris, Elizabeth T. and C. Eugene Steuerle, eds. Nonprofits and Government. Washington, D.C.: The Urban Institute Press.


University of Memphis
Table 1 Number of Health and Human Services Public Charities in the
United States by NTEE Code, (1) 2009 (2)

NTEE Code   Description                                 Number
C           Environmental Quality, Protection, and      28,426
E           Health Care                                 37,681
F           Mental Health, Crisis Intervention          16,500
G           Diseases, Disorders, Medical Disciplines    20,636
H           Medical Research                             3,701
I           Crime and Legal Related                     13,752
J           Employment, Job Related                      7,269
K           Food, Agriculture, and Nutrition             7,024
L           Housing, Shelter                            26,606
M           Public Safety                               13,733
O           Youth Development                           20,832
P           Human Services--Multipurpose and Other      84,585

(1) List does not include the following NTEE Code categories:
A-Arts, Culture and  Humanities, B -Education, D-Animal Related,
N-Recreation,  Sports, Leisure, Athletics, Q-International, Foreign
Affairs and National Security,  R-Civil Rights, Social Action,
Advocacy, S-Community  Improvement, Capacity Building,
T-Philanthropy, Voluntarism, and Grantmaking Foundations, U-Science
and Technology Research Institutes, Services, V-Social Science
Research Institutes, Services, W-Public, Society
Benefit--Multi-purpose and other, X-Religion Related, Spiritual
Development, and Z-Unknown.

(2) Source:
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Author:Norris-Tirrell, Dorothy
Publication:Journal of Health and Human Services Administration
Geographic Code:1USA
Date:Mar 22, 2010
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