Instituting market-based principles within social services for people living with mental illness: The case of the revised ODSP Employment Supports policy.

摘要

Policies are shaped by social values and assumptions, and can significantly impact the delivery of health and social services. Marginalized groups are often disadvantaged in the political realm and reliant on publicly funded services and supports. The purpose of this research is to consider how public policies are constructed and implemented for marginalized groups and to increase understanding of the consequences of policy reform. It draws on a case study of the Ontario Disability Support Program, Employment Supports (ODSP-ES) and considers the impact of the policy revision that occurred in 2006 on employment support services for people living with mental illness. A constructivist grounded theory approach guided data collection and analysis. Key policy documents were analyzed and 25 key informant interviews were conducted with individuals who were involved in: the construction and/or implementation of the policy; developing and/or delivering employment services under the policy; or advocacy work related to the policy.;The findings highlight the impact of outcome-based funding on employment services and practices, and provide lessons for the construction and implementation of public policy for marginalized groups. The new funding system has promoted a shift from a traditional social service model of employment supports towards a marketing model, wherein services focus on increasing job placement and short-term job retention rates. However, the introduction of market principles into employment services has had significant implications for people living with mental illness. Employment programs are required to absorb increased financial risk, thereby altering the way service providers work with clients to help them find and keep jobs; there is a heightened focus on the rapid placement of clients into available jobs and less attention to the quality of employment being achieved and to complex barriers that prevent individuals from succeeding with employment. Although ODSP-ES has been somewhat successful at connecting people with disabilities to competitive employment, it has led to secondary consequences that compromise its overall utility. The findings highlight the complexity of constructing and implementing public policy for marginalized groups and suggest that evaluating public policy is an interpretative exercise that should be explored from multiple perspectives beyond the stated objectives.