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An action research approach to reforming rural health and human services through Medicaid managed care: Implications for the policy sciences

Posted on:2002-11-12Degree:Ph.DType:Dissertation
University:Cornell UniversityCandidate:Boser, Susan RFull Text:PDF
GTID:1464390011496990Subject:Sociology
Abstract/Summary:
Centralized decision making among upper levels of government and special interest groups, focused on targeted social problems, dominates the development of social public policy. This process produces narrowly framed solutions for implementation across broadly diverse settings. The site for the actualization of social policy, the local context, includes local government, service providers, consumers of those services, and the local citizenry. Yet the voice of the local geographic context is underrepresented among those voices shaping social public policy. The centralized policy process places the local government as the implementer of policy determined at higher levels of government, rather than as a partner in the public policy process itself. Thus policymaking processes systematically exclude key stakeholders. The absence of mechanisms for understanding and integrating the local experience into shaping social public policy not only inhibits the amelioration of social problems; in many instances it may worsen conditions and undermine the capacity of the local leadership to respond effectively, as this dissertation demonstrates.; In action research, community inquirers in partnership with a professional researcher systematically construct knowledge regarding locally defined problems in order to generate a contextualized plan for action. When conducted in partnership with local government, action research offers a mechanism for democratizing policymaking through increasing the voice of stakeholders previously excluded from decision making,; This dissertation represents an action research project conducted to develop and advocate for a local solution to problems associated with the design of the human service administrative system. As a representation of the action research project, this dissertation has two objectives. First, through a detailed description of the human service infrastructure in this context, it articulates the local perspective and experience of public policy developed through centralized processes, making the case for democratized policymaking. Second, it provides an analysis of a grassroots effort that sought to influence state public policy by creating and advocating for a contextualized response to a particular policy. Through this, the dissertation demonstrates how the process of local stakeholder participation in policymaking changed both the policy product, namely the program model, as well as the conditions for policy implementation.
Keywords/Search Tags:Policy, Action research, Making, Social, Local, Government, Service, Human
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