This dissertation examines the fiscal and ideological deployments of community in publicly-funded yet independent nonprofit social service and healthcare provision. As at-risk youth leave families-of-origin in two American cities, they encounter a network of nonprofit providers conducting tailored and targeted outreach and managing access to benefits, services, and housing. Clients and outreach workers describe the ways they are monetized in an interconnected system of welfare and service provision and point to an expanding, entrapping, and extractive public health, housing, and benefits structure where community-building is the nonprofit profit mechanism.
Following recent work on the “grow and hide” model of the American health care state (Grogan 2023), this fieldwork investigates on-the-ground impacts of hidden public funding and financing routed through private industry for nonprofit hospitals, clinics, community-based outreach arms, and public health-funded housing that has increased out of sight and without accountability to the public. Through fieldwork inside hospital-based clinics, nonprofit-adjacent “grassroots” campaigns, trade associations, and interviews with agency officials, bankers, nonprofit consultants, executives, and providers, this research untangles a skein of legislation and benefits policies that traps clients in proliferating categories of vulnerability.
The material and psychological consequences of these policies for clients and their providers unspool inside nonprofit hospitals and clinics and their outreach arms—the site of public health intervention research, benefits navigation, and primary care provision in youth public health programs across the country. Within funding eddies enabled by municipal, state, and federal agency contracts with nonprofit service providers across healthcare and housing, a certain kind of client-subject is made who must either perform community or embrace mercenariness in policy-related underground economies. The municipal Community-Based Organization (CBO) and not the family (Cooper 2017) emerges as the unit propped up in the late devolutionary structure of welfare and service provision. State-funded independent nonprofits and their trade associations emerge as key architects from below of an expansive, hidden, and extractive healthcare-welfare state.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/46n9-0p12 |
| Date | January 2024 |
| Creators | Casey, Clare |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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