Uncommon partners: Citizen participation and lay-professional relationships in three community collaboratives for children's mental health.

摘要

As government policies increasingly mandate that community-based citizens partner with professionals to plan, implement and evaluate policy-relevant programs, parents of children with serious emotional disturbances have the opportunity to participate in local "Systems of Care". Within this model, Community Collaboratives are the organizational component serving as de facto planning boards. Open to public attendance and membership, these groups decide how to implement policy in their communities.; Using constructionist and structuration theories, this qualitative study examined how the mandate for lay involvement was manifested in various Collaboratives responding to one northeastern state's reform of children's mental health. The central analytic question was: Given the multiple legitimate and competing goals in the System of Care model, what organizational elements of the Community Collaboratives affected the particular goals (including involving family members) which various groups prioritized?; Three Collaboratives were selected to maximize variability in parental and cross-sector professional involvement. Thirty-four key informants participated in in-depth interviews and monthly meetings of each Collaborative were observed.; A grounded theory analysis revealed that the Collaboratives had different orientations toward lay/citizen participation. One prioritized family involvement. The other groups prioritized different goals; while family members were involved at the periphery of one of these groups, the final Collaborative had no lay involvement. Unlike other studies which identified individual-level factors, this dissertation identified four organizational elements permitting greater and lesser degrees of citizen involvement, namely: (1) The leadership model (which either impeded or facilitated democratic participation and reflexive authority); (2) The shared symbolic meaning held by members about lay participation; (3) The "situated motives" and "accounts" lay members offered for their own involvement in the Collaboratives; and (4) "Social technologies" (especially the role of advocacy groups; and availability of fiscal incentives for lay participants) accessed by the Collaborative with the highest level of family involvement.; While the Systems of Care philosophy extols lay participation, in practice it may not be realized given other legitimate and challenging goals. Sociological and policy implications for democratic (lay) involvement in the mental health policy arena are examined.