Human service organizations are reconfiguring to meet dynamic, complex issues associated with diversifying populations and widening inequality. Programs that tackle such issues need to contend with transformative change within institutions. However, such programming is challenging to implement and challenging to fund; resource scarcity and stakeholder buy-in are barriers to institutional change. In this study, we analyze a funding-driven, state-initiated program to institutional change: our case study is a decade-long, state-wide effort in Minnesota to diversify mental health services and support mental health professionals who are people of color, in order to decrease racial disparities in mental health.
This case study examines the Cultural and Ethnic Minority Infrastructure Grant program of the State of Minnesota, as part of the 2007 Governor’s Mental Health Initiative. Data were documents and stakeholder interviews. We conducted a systematic review of documents, including Request for Proposals (RFPs), RFP responses, grant contracts, grant renewal proposals, and grantee reporting data. We conducted content analysis of interviews with current and former DHS grant program administrators, agency grant managers, and behavioral health board representatives. In a first cycle of coding, provisional codes pertained to broad external and internal organizational factors in program implementation. In the second step to analysis, code mapping and operational model diagramming strategies were conducted to reorganize the codes, and connect and distill concepts into central themes. Pattern coding generated overarching themes created from explanatory or inferential codes that arose in the process.
Two emergent themes, “revolving door” and “under the radar,” portray the struggles in program implementation, while the third theme of “messages of value” shows underlying support for the Program.
First, results show how shifting leadership was problematic: over 10 years, there were nine grant administrators across the two Divisions. High turnover led to confusion, information isolation, lack of continuity and knowledge transfer and poor cohesion. Second, results show how the program was not viewed as a priority by internal leadership, and that there was a lack of clarity about how to define the grant program, the social problem it was designed to address, and appropriate stakeholders. Third, despite issues discussed above, results reveal an overarching message of value. Regardless of the difficulties surrounding the program, everyone emphatically supported its existence and the mission.
Results illustrate how the program struggled with high personnel turnover and uninspired, halfhearted messaging, but was nevertheless well loved. Lack of diversity among mental health providers was the explicit, targeted issue for the program. However, a more fundamental idea underpinning the problem of diversity was institutional racism, and the Program did not go deep enough in addressing and altering this fundamental logic. In other words, the diversity outcomes belied the institutional racism embedded within institutional practice. Drawing upon literature on planning transformative change and institutionalism, we argue that the 'pitch' and leadership matter in programming for institutional change and its contested nature, a contestation that funding alone cannot temper.