Competing institutional logics in the development and implementation of integrated treatment for concurrent disorders in Ontario: A case study
Bibliographic record
Abstract
Summary Rising health care costs have increased scrutiny on the performance of mental health and substance use services. The specifics of these human service organizations’ institutional environments make evaluating their organizational performance a challenging task. This study, based on 27 semi-structured interviews, document analyses and non-participant observation at two treatment programs, explored how two different institutional logics – managerial strategies striving for treatment effectiveness and client-centered care – guide the implementation of integrated treatment for concurrent disorders in Ontario, Canada. Findings Treatment services for concurrent disorders have been pressured to adopt more business-like, performance-oriented rationales that are part of corporatist institutional paradigms including, for example, the spread of managerial strategies focused on developing strong performance culture. Such development, however, can conflict with the principles of client-centered, comprehensive care that social workers and other helping professions adhere to. In this regard, the clash of different rationalities brings inconsistencies to the process of developing and implementing integrated treatments for concurrent disorders. Applications Despite the ideological commitment to comprehensive, individually-tailored and continuous treatment for concurrent disorders, there has been tension between such commitment and the emphasis on abbreviated, manual-based, routinized treatments associated with cost-containment and resource efficiency. This, however, can have serious consequences for treatment planning and treatment delivery, the client-clinician relationship and the displacement of client-centered care by program-centered approaches.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.019 | 0.006 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".