The Paradox of Engagement: How Political, Organizational, and Evaluative Demands Can Hinder Innovation in Community Mental Health Services

Abstract

The Connecticut Peer Engagement Specialist Initiative was a randomized controlled trial that assessed whether peer staff on community mental health teams could engage into services individuals with serious mental illness and a history of violence. There is evidence that peer workers were effective at getting people connected with services, but policy makers deemed the initiative a failure. This disconnect occurred because political, organizational, and evaluative demands created disjunctures between political expectations and programmatic capacities. Thus, peer specialists were not able to help their clients in ways directly relevant to policy makers, a situation that can be called the paradox of engagement.