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

Authors

  • Kimberly Roussin Isett,

    Corresponding author
    1. Columbia University
      Kimberly Roussin Isett is an assistant professor at the Mailman School of Public Health at Columbia University. She received her doctorate in 2001 from the School of Public Administration and Policy at the University of Arizona. Her interests include 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. E-mail:ki2129@columbia.edu.
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  • Joseph P. Morrissey,

    Corresponding author
    1. University of North Carolina at Chapel Hill
      Joseph P. Morrissey is a professor of health policy and administration in the School of Public Health and deputy director for research at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. He is 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. E-mail:joe_morrissey@unc.edu.
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  • Sharon Topping

    Corresponding author
    1. University of Southern Mississippi
      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 fields. E-mail:s.topping@usm.edu.
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Kimberly Roussin Isett is an assistant professor at the Mailman School of Public Health at Columbia University. She received her doctorate in 2001 from the School of Public Administration and Policy at the University of Arizona. Her interests include 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. E-mail:ki2129@columbia.edu.

Joseph P. Morrissey is a professor of health policy and administration in the School of Public Health and deputy director for research at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. He is 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. E-mail:joe_morrissey@unc.edu.

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 fields. E-mail:s.topping@usm.edu.

Abstract

This article examines the stability of street-level bureaucrats’ negative perceptions regarding a newly implemented managed care system on quality of care and service delivery in a publicly funded behavioral health care system. Overall findings indicate that the generally negative perception of managed care did not differ between staff in the two programs, indicating a weak effect on attitudes of frontline workers. More proximal variables to the caregiver, such as service type and job title, show more influence on attitudes. The conclusion discusses the implications of these findings for practicing administrators and academic researchers.

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