Systems Ideologies and Street-Level Bureaucrats: Policy Change and Perceptions of Quality in a Behavioral Health Care System

Abstract

alternative governance arrangements, especially networks; current and past research focuses on the delivery of services to individuals with severe and persistent mental illness who are dependent on government-funded mental health care. interested in how communities adapt to policy and program changes and how multiple and diverse community agencies coordinate their activities to provide comprehensive treatment and support services for persons with severe mental illness. Sharon Topping is a professor of management at the University of Southern Mississippi. Her research focuses on system-and organization-level change, network structure in the delivery of care, the diffusion of practice innovations, and group development, particularly in multidisciplinary teams.Before receiving her doctorate, she spent more than 15 years experience in the accounting and consulting fi elds.

Managed Care and Provider Satisfaction in Mental Health Settings

“…Both of the interpretations offered above for the impact of low job satisfaction on change initiatives suggest that the antecedents and consequences of low morale and low job satisfaction among mental health clinicians in mental health agencies must be addressed in current systems change efforts throughout the public mental health system much more centrally than they have been to date. Over and above the impact of job satisfaction attitudes on change efforts, low satisfaction with large caseloads and compensation for some key clinical groups-important proximal variables in the daily lives of the mental health care workforce (Isett et al 2006;Strauss 1981)-could have an impact on retention and growth of the current workforce.…”

“…TMCS compared two different organizational and financing arrangements for services to adults with SMI who were enrolled in Medicaid in two regions of eastern Virginia (Fried et al 2000;Isett et al 2006;Morrissey et al 2002;Stroup et al 2001). In 1996 under a Sect.…”

Leadership in Street-Level Bureaucracy: An Exploratory Study of Supervisor-Worker Interactions in Emergency Medical Services

“…Given that many of these decisions are shaped through experience with particular types of situation and experiential learning, this lends support for theories of street-level bureaucracy that place emphasis on occupational culture (Isett, Morrissey, and Topping, 2006;Riccucci, 2005;Sandfort, 2000). Likewise, an understanding of the possible outcomes both for crew members and patients was crucial in understanding the decision to comply or deviate.…”

“…Rules are influential in shaping behavior, as are organizational and occupational culture (Isett, Morrissey, and Topping, 2006;Kelly, 1994;Sandfort, 2000;Riccucci, 2005), and extraorganizational sources of influence, including direct and indirect relationships with political principals (Gilboy, 1992;May and Winter, 2007).…”

“…Past research on street-level bureaucracy has focused on several occupational areas, including law enforcement, nursing, welfare eligibility workers, and teachers (Isett, Morrissey, and Topping, 2006;Maynard-Moody and Musheno, 2003;Riccucci, 2005), on the influence of management in frontline decision making (May and Winter, 2007;Riccucci, 2005), and on concepts of leadership in street-level services (Vinzant and Crothers, 1994, 1996, 1998. These studies have established a foundation of knowledge that makes clear the importance of street-level workers in the implementation of policy, highlights the role of discretion and legitimacy in this process, and examines the relationship between frontline workers and direct supervisors.…”