“Creaming” at social and health care services on practitioners’ perceptions: challenges for addiction treatment programs

Elena Zagorianakou, MSc & Gerasimos D. Papanastasatos, Ph.D

DOI: https://doi.org/10.57160/VREL8892


The current study explores the practitioners’ perceptions working in social and health care services about client selective practices – called “creaming” – in terms of adequacy and unbiased care provision. The scope of the research focuses on whether employees identify practices of creaming, signs of selective behaviours as well as other employee and organizational behaviour aspects. A qualitative study was conducted using in-depth semi-structured interviews. In order to analyse data, content analysis methodology was performed. Findings of the study did not identify institutional creaming. Meanwhile, stereotypes emerged by professionals, who appear to raise informal barriers to the right of access to some type of services for certain groups of beneficiaries. In addition, employees’ perceptions focused on parameters related to the occurrence of the phenomenon, the way creaming is manifested, the role of organisation’s management and how creaming is dealt with. The phenomenon is challenging for addiction treatment programs, which experience a pressure for effective performance as expressed through indicators tailored for activities not related to social and health care.


Corresponding Author: Elena Zagorianakou,  e.zagorianakou@hotmail.com

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