One of the enduring problems in behavioral health systems reform and advocacy is to realize the vision of person-centered, and person-driven, living, within the machine/computer models of modern bureaucratic systems of service and supports delivery. The approaches to resolving the tension between these paths to realizing person centered and driven planning and living has drawn on two repeatedly used tactics:
•Iterative and incremental improvement in the macro-system while maintaining that current system’s underlying CAS logic
•Creation of novel frameworks in a micro-system from the bottom up with a view to advocating for them to be embraced by the macro-system.
These two approaches to change each have their own problems in their ability to move us effectively toward a scaled person centered and person driven planning and living reality. They also actively interfere with each other when advocates attempt to use the innovative micro-system to alter the logic of the macro-system. This can be seen in the endless arguments over the best method to advocate for change toward our valued outcomes.
The most obvious problem with building a model of supports consistent with social justice and trying to use it to leverage change in the macro-system is that the logic of the macro-system will largely, if not entirely, try to absorb the meaning of the social justice innovation and minimize its need to change. Yet, it always seems impractical to somehow replace the macro-system wholesale with a CAS that truly reflects valued social justice outcomes.
I would suggest that we look to the building of supports from the bottom up without any plan to integrate them into the macro-system of supports, specifically to avoid having the macro-system’s logic applied to these supports. In fact, I suggest that we build supports in a hundred different ways from the bottom up without integration of our innovations in the macro-system as the outcome. Further, I would suggest that our outcome be the creation of an advocacy and supports ecosystem that can compete in some arena with the current macro-system. The next Part of this series of posts will explore how we might approach such an outcome. But first we need to understand more concretely how emergence occurs in our potential advocacy ecosystem.
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