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Payment by Results. Challenges and Contradictions for the Therapeutic Community

Gosling, HJ (2016) Payment by Results. Challenges and Contradictions for the Therapeutic Community. Criminology and Criminal Justice. ISSN 1748-8966

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Abstract

Drawing upon the findings of a 31month ethnographic study in a residential Therapeutic Community (TC) for substance use, this article sheds light on the challenges and contradictions which surround the introduction of increasingly commercial/business orientated decisions within the alcohol and drug treatment field. The aim of this paper is to critically reflect upon the implementation of an outcome-orientated policy directive, typically referred to as Payment by Results (PbR), in a residential rehabilitation service, and consider the implications which surround the initiative for those at the coal face of service delivery. The fundamental principles of PbR and the TC are discussed, as are the tensions and dilemmas which surround the implementation of a high-level policy directive that is fundamentally dissimilar to the theoretical ambitions and practice that takes place on the ground in a residential rehabilitation service. To conclude, the article suggests that incentives, with a clear focus on saving money rather than saving lives, provide little more than additional pressures and strains at the coal face of service delivery, transforming individual progression into a financially-driven bureaucratic process. The findings not only illustrate the dehumanising properties of outcome-based payment schemes but bring mainstream representations of effectiveness into sharp focus.

Item Type: Article
Uncontrolled Keywords: 1602 Criminology
Subjects: H Social Sciences > HV Social pathology. Social and public welfare. Criminology
Divisions: School of Law
Publisher: SAGE Publications (UK and US)
Date Deposited: 09 Mar 2016 13:24
Last Modified: 24 May 2016 14:07
URI: http://researchonline.ljmu.ac.uk/id/eprint/3120

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