TY - JOUR
T1 - Shifting practices of recovery under community mental health reform
T2 - A street-level organizational ethnography
AU - Spitzmueller, Matthew C.
N1 - Funding Information:
Between 2004–2008, the Illinois Department of Mental Health (IDMH) undertook a comprehensive systems restructuring initiative to convert community mental health funding from a block grant to a Medicaid fee-for-service model. In his second annual budget address, then Illinois Governor, Rod ), announced ‘the days of social service providers getting blank checks, with no questions asked have to come to an end.’ He estimated that Illinois could save $60 million annually by converting its block grant system, for which the state paid 100 percent of costs, to a Medicaid fee-for-service system that would pay a 50 percent federal assistance percentage match for all valid services. The Governor averred, ‘by asking questions, by demanding accountability, and by doing more with the resources available to us, we can afford to offer health care and social services to more people who need them.’ His political promises seamlessly combined the aspirational logics of fiscal austerity, enhanced efficiency, greater accountability, and improved care. The guiding question for this study is what became of these aspirations when financial and managerial reforms touched down at the street-level.
PY - 2014/1
Y1 - 2014/1
N2 - This article is part of a larger ethnographic study that seeks to understand how community mental health practice has changed over time in response to shifts in Medicaid management and financing. In this article, I examine the struggle that took place on the ground in one emblematic community mental health agency as frontline workers strived to realize their 'recovery' vision under emerging managerial arrangements of fee-for-service billing. This study finds that managerial reforms conflict with locally forged practices that emphasize self-determination and program responsiveness. By analyzing how street-level workers respond to formal policy in a real-time, situated context, this article gives greater transparency to policies that are otherwise uncertain, providing a fuller picture of how policy is produced in everyday life.
AB - This article is part of a larger ethnographic study that seeks to understand how community mental health practice has changed over time in response to shifts in Medicaid management and financing. In this article, I examine the struggle that took place on the ground in one emblematic community mental health agency as frontline workers strived to realize their 'recovery' vision under emerging managerial arrangements of fee-for-service billing. This study finds that managerial reforms conflict with locally forged practices that emphasize self-determination and program responsiveness. By analyzing how street-level workers respond to formal policy in a real-time, situated context, this article gives greater transparency to policies that are otherwise uncertain, providing a fuller picture of how policy is produced in everyday life.
KW - Community mental health practice
KW - Medicaid policy
KW - ethnography
KW - organizational management
KW - recovery
UR - http://www.scopus.com/inward/record.url?scp=84890917206&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890917206&partnerID=8YFLogxK
U2 - 10.1177/1473325013507472
DO - 10.1177/1473325013507472
M3 - Article
AN - SCOPUS:84890917206
VL - 13
SP - 26
EP - 48
JO - Qualitative Social Work
JF - Qualitative Social Work
SN - 1473-3250
IS - 1
ER -