Shifting practices of recovery under community mental health reform: A street-level organizational ethnography

Abstract

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.