Competing institutional logics in the development and implementation of integrated treatment for concurrent disorders in Ontario: A case study

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.