This article brings street-level organizational theory into conversation with the institutional logics perspective. It uses ethnographic methods to investigate how workers in one community mental health organization negotiated the competing therapeutic logic of the clubhouse and managerial logic of fee-for-service reforms, analyzing how their actions shaped the accessibility of services for those most in need. This article examines the organizational products of new managerial reforms and the structures that were most decisive in shaping them. It finds that reforms in financing and governance produced unresolvable contradictions at the street level, restructured workers’ perceptions of problem clients, shifted workers’ conceptions of the work role, and led to service rationing. I conclude by reflecting on what these findings mean for the development of organizational theory and the project of improving the accessibility of community mental health services.
- Community mental health practice
- Medicaid reform
- Mental health policy
- Mental health service access
- Organizational behavior and management
ASJC Scopus subject areas
- Sociology and Political Science