Poster Presenters - Community Based Organization Category

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Q1 Please provide your contact information below.


Title and Organization


Address 2



ZIP/Postal Code

Email Address

Phone Number

Sabina Shakya

Program Officer, Single Stop USA

123 William Street

Suite 901

New York City




Q2 Please describe your company or organizations overall goals and mission.

Single Stop is a national anti–poverty organization that has served low–income individuals and families for the last 11 years. Single Stop strives to build pathways out of poverty by leveraging partnerships and technology to connect people to existing resources. Our vision is for every individual to have access to existing opportunities for achieving the American Dream.

Single Stop uses a "one–stop shop" model to coordinate access to resources that help low–income clients secure public benefits access, access to higher education opportunities, and achieve financial self–sufficiency. As an umbrella organization, we work with a network of over 100 organizations to implement our program model. Our partner organizations are diverse, ranging in size from small agencies to large institutions, and includes community–based organizations such as settlement houses and food pantries, hospitals, community colleges, and legal service providers.

Single Stop´s model is designed to help low–income families and individuals reach financial stability and lift them out of poverty by providing them access to the full spectrum of benefits and resources available to them. We do this by providing training, technology, and technical assistance to our partners, who then implement the program at their location and connect clients to all the resources they are eligible for. Our services include benefits screening, application assistance, and holistic case management, as we well as connections to other services including free tax preparation, financial counselling, and civil legal service.

Q3 Please indicate which category your organization falls under.

Community Based Organization

Q4 Innovation Executive Summary. Please describe the innovation, and how it addresses the social determinants of health. Please identify how the innovation addresses the 6 innovation criteria (i.e. ROI, scalability, feasibility, evidence–based support for innovation, relevance to the Medicaid population and speed to market).

The Single Stop Program Model:
Single Stop works with community partners to build networks that can provide holistic support to low–income families and individuals. Single Stop service networks are community coalitions that provide streamlined access to social supports for people in need. Based on a shared purpose and mission and with a governance structure to ensure accountability of all members, the networks are efficient and solution–based supports that wrap comprehensive supports around community members in need with a goal of economic self–sufficiency for families and individuals.

When an individual experiences basic needs insecurity, such as lack of healthy food options, inconsistent housing, and limited safe spaces, it negatively impacts their health and well–being. Systems that enable low–income people to access services that address the social determinants of health can be complex and challenging for them to navigate, particularly for people who are dealing with a multitude of issues, such as finding their next meal or a place to sleep for the night. It is a well–recognized fact that the health of a patient is deeply rooted and influenced by various social factors that individuals face on a day–to–day basis. The lack of access to basic resources such as food and housing, and lagging economic stability have a direct and negative correlation with the quality of life and health of an individual. Challenges with accessing services can lead to frustration and oftentimes poor choices that can negatively impact a person´s health and financial situation further. For example, with limited economic support, low–income individuals are more likely to choose inexpensive food items, which are often malnourishing. An unhealthy diet leads to chronic diseases, such as high blood pressure, high cholesterol, lower physical functioning, and mental health problems. Since stressful environments induce health issues, it is important that we address housing, nutrition, education, employment, and the other social determinants of health.

With the mission of getting low–income families out of poverty, Single Stop attempts to break the cycle of poverty by connecting the underserved to the already existing myriad of services available to them. In doing so, Single Stop strives to help individuals reach financial stability, consequently enabling them to live healthier lives. The key lies in recognizing the need to connect an individual to multiple benefits to create this impact. Single Stop networks do just that. Single Stop´s approach of developing a community network takes the principles of a one–stop to connect the community service agencies in a way that leverages the services already available to create a truly streamlined system of support for people in need. The power of the community together is more effective than each individual agency, many of which focus on only one or a few needs, limiting a person´s ability to see a real path forward.

Single Stop partners with a lead organization or agency in the community to create a network that provides streamlined access to social service supports for people in need that not only move them past immediate issues but strives to be a springboard for long term sustainability. Single Stop provides program and network set–up and operational support, training, technology to screen and refer clients for benefits and other critical social services across the network, reporting tools, and continuous learning resources. As part of our strategic planning services, we work with the lead agency to ensure that organizations that provide all of the services important for the population they serve are engaged in the service referral network. For example, at Single Stop hubs, we train staff to provide connections to economic stability and health programs such as the Supplemental Nutrition Assistance Program (SNAP), free and low– cost health insurance, and financial capability services. We ensure that organizations that can provide services to address all of the social determinants of health are included in the network.

Among Single Stop´s tools are two web–based technology products that provide the infrastructure to the Single Stop network and facilitate access to a multitude of essential benefits and services that address the social determinants of health.

Single Stop Technology is an innovative platform that allows clients and providers alike to do a detailed eligibility screening for public benefit program and locate network partners on a map. It also allows case workers to track the assistance that has been provided to the client through a case management portal. Single Stop Technology asks a series of simple questions that determines what existing programs one could be eligible for and acts as a central hub for connecting clients with the resources they need. As clients move throughout the network, the services they are connected with are recorded in the technology, and that data populates reports though Tableau, a best–in–class visualization software.

Through our technology, a single client can be screened for and connected to the resources in 17 categories of service: Child Care, Documentation, Education, Emergency, Financial Capability, Food, Goods, Health, Housing, Immigration, Legal, Money, Taxes, Transportation, Utilities, Veterans, and Work. Some examples of these comprehensive services that Single Stop partners help clients access include:

  • Food: Clients can get assistance applying for public benefits such as the Supplemental Nutrition Assistance Program (SNAP) and WIC, and they can get assistance finding local organizations that help them get food immediately.
  • Health Insurance: Clients can be screened for free or low–cost health insurance and can get assistance applying for programs. Clients can also be connected to low–cost clinics for general health, mental health and dental services, recovery centers, and health education.
  • Education: Clients can be connected to training organizations, local free or low–cost pre–school and after school programs for children, and financial aid for college.
  • Work: Eligible clients can be connected to job training programs, and organizations that train them with new and in–demand skills that help you find a job.
  • Legal Assistance: Clients can be connected to attorneys and legal organizations that provide assistance with a variety of pro–bono legal services.
  • Immigration Assistance: Clients can be directed to organizations that help with immigration, refugee re–settlement, citizenship application, and ESL.
  • Housing Assistance: Clients can be directed to organizations that assist with a variety of housing issues.
  • Transportation: Clients can be connected to free and low–cost transportation options in their communities.

Single Stop Connects is a companion tool to Single Stop Technology, which facilitates automatic referrals throughout the network so that clients can more easily access the resources that best meet their needs. Connects is an easy–to–use and innovative web–based app that allows clients to self–screen or allows providers to easily screen clients for the Earned Income Tax Credit (EITC), SNAP and WIC within a span of two minutes. If eligible, individuals can send their name and contact information through an automated referral to the appropriate location in the Single Stop network. The tool will be available to use in multiple languages and be certified for screen reading so that it can be used by as many clients as possible. Because the technology has been built and maintained in–house, our technology developers can add additional screening criteria as needed.

Potential Return on Investment:
Single Stop has implemented our community network–building approach throughout the state of New Jersey. In 2015, we received a grant to implement the Single Stop program in targeted counties in the state. Year–over–year our program has shown significant growth, proving our concept and positioning Single Stop for further expansion. Based on a budget of $1.4 million per year in New Jersey, in 2015 Single Stop served about 2,700 households, drawing down $4.6 million in benefits and services for clients. In 2016, Single Stop served 5,350 households, resulting in a drawdown of $10 million. In 2017, it increased to 17,472 households, with a resulting drawdown of $32.5 million. In quarter one of 2018, Single Stop has served about 24,000 households with a $34.8 million drawdown. The ROI in New Jersey was 7:1 in 2015 and has increased each year–to 9:1, then 23:1, and then to 49:1. Over the whole time period of 2015 to quarter one of 2018, the total ROI was 21:1. We expect we would see a similar ROI implementing this model in the health care space.

As web–based portals, Single Stop Technology and Single Stop Connects are available on all mobile devices from any geographical location and are build out to include the benefits eligibility rules at a statewide level. Both tools require only simple customization to tailor the sites to a partner organization´s needs, including site–specific branding and information for network partners. Partners are given their own unique URL to access Single Stop Technology once it is customized for their network. Similarly, partners have unique logins to Single Stop Connects. Given the ease of access to utilizing our technology platforms, expanding the usage of both the Single Stop Technology and Single Stop Connects is practical and scalable.

Similarly, the network set up and partner engagement is scalable because the same set of tools are used for each network. While the needs of each community vary based on the services available and the client population served, the same process can be used for strategic planning, site set up, and training.

We also offer a variety of web–based tools and trainings that are available to partners throughout the country. For example, all partners have access to our online learning community where staff can complete training modules, meet learning goals, and access up–to–date resource toolkits and best practices guides.

The Single Stop Technology has already been used to scale the Single Stop program since its launch in 2015. The technology was first developed in New York City and was piloted and launched in 2015 in five different states: New York, Florida, Louisiana, California and North Carolina. With the success of our pilot program, Single Stop has since launched the technology throughout all 11 states that Single Stop operates in, including: New York, New Jersey, Massachusetts, North Carolina, Louisiana, Pennsylvania, Mississippi, Florida, Rhode Island, Oregon and Virginia. It has been instrumental in supporting the scaling of our community network approach.

Similarly, Single Stop Connects was first deployed in 2017 and is expanding the referrals capability across our networks. With the expansion of our programs, Single Stop Technology and Single Stop Connects are continually being enhanced to meet the screening, case management, and reporting needs of partners and to improving the scalability of the program.

Single Stop is a holistic solution that provides greater access to services that address the social determinants of health, by improving the coordination of service providers and by building capacity to serve clients within existing organizations. Single Stop has already developed the tools, technology, and training required to implement the model.

Single Stop recognizes that communities have unique client populations and needs and a range of partners. As such, we´ve developed a model that enables flexibility of partnership while providing a structure and set of tools to ensure effective program implementation and service access. There are three levels of partnership in the network and program service delivery and on–going support is based on these levels. These levels are:

  1. Network Lead: The primary Single Stop location where full Single Stop supports are provided. These include benefits screening and application assistance, comprehensive case management, and connections to other community resources. The lead is also the key facilitator of network growth and community integration.
  2. Enrollment Partner: A secondary location for benefits enrollment.
  3. Service Partner: Provides a critical service to people in need, such as financial counseling services, re–entry support, or health services.

Single Stop offers affordable pricing options for all three levels, which is the highest in year one because it includes consulting and set– up services. The cost decrease in years two and three, at which point the service is offered for just an annual licensing fee.

The consulting and set–up services include services such as network strategy and sustainability planning, training for site staff, program integration consulting, technology customization, and consulting on the best placement and integration of Single Stop Connects. Annual support includes services such as ongoing technical assistance, access to Single Stop´s National Learning platform and community, and operational guides and best practices.

Evidence–based support for innovation
The Single Stop program has undergone two independent evaluations, which have shown statistically significant results that the program is improving client outcomes. These evaluations focused on the use of Single Stop services by community college students.

In a study of first–time–in–college students at four community college systems during fall 2014 conducted by RAND Corporation, Single Stop use was associated with an increase in college persistence of at least 3 percentage points. Single Stop users also attempted more credits than comparable students who did not use Single Stop. Results were especially strong for users 25 and older, independent students, and non–white students. In a study conducted by Metis at the Community College of Philadelphia, Single Stop users had higher semester persistence, a higher ratio of completed to attempted degree–bearing credits, and higher GPAs.

Single Stop has also performed qualitative analyses of our program and our technology tools. For example, we conducted focus groups with our client population, soliciting input on the use of Single Stop Technology. That analysis showed that participants believe the technology is clear and easy–to–use. They felt that the tool was personally empowering and safe and would allow them to receive help without judgement or condescension.

Relevance to the Medicaid Population:
Single Stop´s client population primarily consists of families and individuals with little to no income. Through Single Stop´s Healthcare Access Programs, Single Stop has assisted with health insurance enrollment applications through New York State Department of Health for more than 5,730 households in 2017, of which 8,934 individuals were enrolled in health insurance coverage. Of these enrollments, 71% were for Medicaid. The high volume of our client population who are Medicaid eligible means that they are also eligible for a plethora of other benefits. Therefore, our typical client is an ideal target for services that address the social determinants of health. In working with other healthcare providers and organizations such as "safety net hospitals" or hospitals and healthcare systems that serve a large proportion of low–income individuals in the community, the combination of utilizing the Single Stop program model with the full integration of the two Single Stop technological platforms, would assist those most in need in our communities.

Speed to Market (how quickly the strategy can be launched):
New partners enter into a contract with Single Stop to joining our network and access the suite of services, technology, and training we provide. Upon doing so, Single Stop works with our new partners to provide strategic planning for creating a network and maximizing the use of our resources and technology to best service their clients. During a launch process, we customize our technology tools for the partner, train staff, and consult on how to best structure the network and how to engage additional partners. Once this process is complete, the partner site can then start serving clients and connecting them to resources that address the social determinants of health. While the launch process can vary from agency to agency, and from state to state, the entire process from initial contact with Single Stop, to opening the site for service typically takes about three months.

Q5 Was your innovation implemented? If so, please explain when, the number of people impacted, and the results.

Yes (please specify when and the estimated number of people impacted):

Since its inception in 2007, Single Stop has serviced more than 1.7 million households, resulting in a total draw down of 5.6 billion dollars in benefits and services. Additionally, to date, more than 372,145 unique households have been confirmed for at least one type of benefit. Among all the resources and programs that Single Stop clients get assistance with, 179,612 households enrolled into SNAP (Supplemental Nutrition Assistance Program) and 85,246 households enrolled into public health insurance. Other popular services that Single Stop clients have received over the years includes food pantry referrals (57,447 households), general medical assistance (18,565 households), sliding scale health care referrals (14,199 households), and pharmacy assistance (12,111 households). Since its launch in 2015, Single Stop Technology specifically has been used to assess benefit program eligibility for 100,132 households, of which 41,360 households have been confirmed for at least one benefit or referral. In total, 5,733 household have received financial services, 8,458 households have received legal assistance, and 9,307 households have received tax services. The Single Stop program model and technologies has evidently created tremendous impact, and is a simple, yet revolutionary solution that creates pathways to tackle the social determinants of health.

Q6 Please identify the SDH Domain that your innovation addresses. (Select all that apply.)


Health and Health Care,

Neighborhood and Environment,

Economic Stability

Q7 I give the Department of Health the right to share the information submitted in this application publicly (for example: on the DOH website). I understand that there is no monetary reward/reimbursement for my submission or for attending the summit should my innovation be selected.

I consent to have my innovation shared