How case management staff and mothers experienced a transition to medical homes

Public health leaders around the United States are experimenting with a range of models intended to better integrate services for individuals with complex needs. In North Carolina, state agencies recently restructured services for low income pregnant women and young children at risk of developmental delays into medical homes models. The current comparative case study examined how this transition was experienced in communities around the state. Results indicate that: (1) The new program increased the centrality of medical providers; (2) Front line staff re-interpreted policies to fit their public health values; and (3) Case managers struggled with the transition from relational toward rationalized services to mothers. Using a political economy perspective, these changes are interpreted as reflecting shifts in the broader ideological environment. To a large extent, the state appeared to succeed in prescribing more connection between health department-based case managers and community clinical providers. How...