Survival models of community tenure and length of hospital stay for the seriously mentally ill : a 10-year perspective

Objective: To examine the effects of personal and community characteristics, specifically race and rurality, on lengths of state psychiatric hospital and community stays using maximum likelihood survival analysis with a special emphasis on change over a ten year period of time. Data Sources: We used the administrative data of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) from 1982-1991 and the Area Resources File (ARF). Given these two sources, we constructed a history file for each individual who entered the state psychiatric system over the ten year period. Histories included demographic, treatment, and community characteristics. Study Design: We used a longitudinal, population-based design with maximum likelihood estimation of survival models. We presented a random effects model with unobserved heterogeneity that was independent of observed covariates. The key dependent variables were lengths of inpatient stay and subsequent length of community stay. Explanatory variables measured personal, diagnostic, and community characteristics, as well as controls for calendar time. Data Collection: This study used secondary, administrative, and health planning data. Principal Findings: African-American clients leave the community more quickly than whites. After controlling for other characteristics, however, race does not affect hospital length of stay. Rurality does not affect length of community stays once other personal and community characteristics are controlled for. However, people from rural areas have longer hospital stays even after controlling for personal and community characteristics. The effects of time are significantly smaller than expected. Diagnostic composition effects and a decrease in the rate of first inpatient admissions explain part of this reduced impact of time. We also find strong evidence for the existence of unobserved heterogeneity in both types of stays and adjust for this in our final models. Conclusions: Our results show that information on client characteristics available from inpatient stay records is useful in predicting not only the length of inpatient stay but also the length of the subsequent community stay. This information can be used to target increased discharge planning for those at risk of more rapid readmission to inpatient care. Correlation across observed and unobserved factors affecting length of stay has significant effects on the measurement of relationships between individual factors and lengths of stay. Thus, it is important to control for both observed and unobserved factors in estimation.

E-mail in the workplace : the role of stress appraisals and normative response pressure in the relationship between email stressors and employee strain

In many organizations, e-mail is an effective and dominant workplace application tool; however, research identifying its role as a potential workplace stressor remains limited. Utilizing the Transactional Model of Stress (Lazarus & Folkman, 1984), 215 full-time administrative and academic staff at a university were surveyed about workplace e-mail. The aim was to study the effects of potential e-mail stressors on emotional exhaustion as mediated and moderated by person and situation variables. Results indicated that 2 distinct e-mail stressors—high quantity and poor quality (in terms of high emotionality and ambiguity) of workplace e-mail—were associated both with stress appraisals (e-mail overload and e-mail uncertainty) and with emotional exhaustion. Furthermore, the effects of the 2 e-mail stressors on emotional exhaustion were mediated by appraised e-mail overload. Perceived normative response pressure—a relevant aspect of the specific work environment—added to the explanation of emotional exhaustion and accentuated the positive effect of e-mail ambiguity on emotional exhaustion, although effects involving normative response pressure were not explained by the stress appraisals.

A Story of Organized Crime: Constructing Criminality and Building Institutions

This is a narrative about the way in which a category of crime-to-be-combated is constructed through the discipline of criminology and the agents of discipline in criminal justice. The aim was to examine organized crime through the eyes of those whose job it is to fight it (and define it), and in doing so investigate the ways social problems surface as sites for state intervention. A genealogy of organized crime within criminological thought was completed, demonstrating that there are a range of different ways organized crime has been constructed within the social scientific discipline, and each of these were influenced by the social context, political winds and intellectual climate of the time. Following this first finding, in-depth qualitative interviews were conducted with individuals who had worked at the apex of the policing of organized crime in Australia, in order to trace their understandings of organized crime across recent history. It was found that organized crime can be understood as an object of the discourse of the politics of law and order, the discourse of international securitization, new public management in policing business, and involves the forging of outlaw identities. Therefore, there are multiple meanings of organized crime that have arisen from an interconnected set of social, political, moral and bureaucratic discourses. The institutional response to organized crime, including law and policing, was subsequently examined. An extensive legislative framework has been enacted at multiple jurisdictional levels, and the problem of organized crime was found to be deserving of unique institutional powers and configurations to deal with it. The social problem of organized crime, as constituted by the discourses mapped out in this research, has led to a new generation of increasingly preemptive and punitive laws, and the creation of new state agencies with amplified powers. That is, the response to organized crime, with a focus on criminalization and enforcement, has been driven and shaped by the four discourses and the way in which the phenomenon is constructed within them. An appreciation of the nexus between the emergence of the social problem, and the formation of institutions in response to it, is important in developing a more complete understanding of the various dimensions of organized crime.

Multi-victim sexual assault : a case study in rural Australia

Objective: There is a paucity of information regarding cases of multi-victim sexual assault of children. The reported incidence suggests that these cases are rare. The aim of this paper is to provide practitioners with information about effective intervention strategies arising out of the direct experience of managing a case of multi-victim sexual assault in an Australian rural community. --------- Method: A descriptive, case-report methodology summarizing the investigation and intervention in a case of multi-victim sexual assault is reported. A community based intervention arising out of the disclosures of 21 male children is described. The intervention occurred at an individual, group, and community level using a coordinated multi-disciplinary team and natural helping networks. ---------- Results: The coordination of police and welfare services increased the communication flow to victims, their families, and the community. The case also demonstrated the utility in regularly briefing political and bureaucratic authorities as well as local officials about emergent issues. Coordinating political and bureaucratic responses was essential in obtaining ongoing support and sufficient researching to enable the effective delivery of services. ---------- Conclusions: Interventions were focused at an individual, group, and community level using a coordinated multi-disciplinary team and natural helping networks. This provided a choice of services which were sensitive to the case setting. Recommendations are offered for practitioners who are confronted with similar events. While this paper describes an approach for intervening in a case of multi-victim sexual assault, further empirical research is needed to enable service deliverers to efficaciously target interventions which offer choice to victims and their families.

From the panopticon to the playground : disciplinary practices

It is easy to take many of the practices that constitute the contemporary school for granted. Timetables, academic records, rows of desks, playgrounds, guidance counsellors now all seem a natural and inevitable part of an optimal learning environment. However, the evidence suggests that they did not appear by chance. Instead, they were put in place, albeit often in a piecemeal and haphazard way, as part of the process by which a new type of institution was constructed. By understanding the school as a disciplinary society, constituted through a variety of diverse practices, it becomes possible to re-interpret the way we have come to educate ourselves. No longer is the modern school some kind of pedagogic inevitability—simply the best and most obvious way to educate, the end result of two thousand years of trying to finally get it right. Rather, mass schooling, as we know it, is an historical by-product of changes in the way society was organised. It is a contingent collection of particular forms of government, deployed at different historical moments, often for quite different administrative and educational reasons.

Shaping the at-risk youth

The category of the `at-risk' youth currently underpins a good deal of youth policy. Primarily, it centres around a range of programs associated with the need for state intervention. The `at-risk' youth tenuously appears at the intersection of a variety of knowledges/problematisations, such as vocational guidance, youth welfare, family management, and so on. Whilst it is argued that in some ways, the `at-risk' youth simply replaces older characterisations used in the policing of the young, it will also be argued that the preventative policies associated with `risk' are constituted in terms of factors rather than individuals, that prevention is no longer primarily based upon personal expertise, but rather upon the gathering and collation of statistical knowledge which identifies `risks' within given populations, and that `risk' legitimates unlimited governmental intervention. Importantly, the category of the `at-risk' youth underpins crucial sections of policy documents such as the Finn Report (into credentialling/education and vocational competency). In this case, youth is deemed to be `at-risk' of not making the transition to adulthood successfully. It will be argued that not only is the Finn Report significant in the administrative and cultural shaping of the category of `youth', but also by employing the notion of `risk', the Report puts in place yet another element of an effective network of governmental intelligibility covering the young. Finally, it will be argued that young women, as a specific an example of a `risk' group (vis-a-vis obtaining certain types of employment), require particular forms of intervention, primarily through changing the vocational aspirations of their parents.

Capturing organisational innovation in construction project procurement

Management of change in construction organisations to capture internal knowledge and maximise innovation is central to construction process re-engineering. Recent international trends toward privatisation and outsourcing of many government functions has seen wholesale changes to the role of government departments. In Brisbane, Australia, the Port of Brisbane Corporation has responsibilities for development and maintenance of all port and harbour facilities in the Brisbane region. The PBC is an acknowledged leader in encouraging internal technical development. Yet 20 years ago, this organisation operated as a small division within a large and bureaucratic Queensland Government public service department. This paper reviews construction project procurement strategies for the port’s civil and structural facilities since a separate organisational entity with responsibilities for Port of Brisbane was formed in 1976. The Port of Brisbane Corporation serves as an initial case study setting for a larger research project studying innovative practices in the context of the trend towards corporatising and privatising public sector organisations.

Seeking inclusion : views from ‘vulnerable’ communities about reporting by the Australian news media

This conference paper reports on the findings of the 'Vulnerability and the News Media’ project about news reporting on communities that are commonly regarded as ‘vulnerable’ by virtue of their issues or circumstances. The project focuses on news reporting of Indigenous and ethnically diverse communities, as well as people affected by mental health issues, people with disabilities, and survivors of crime and traumatic events. Numerous educational initiatives have tried to improve the quality of media reports about these communities and their issues. Despite this, the project’s research with stakeholders from those communities has found that they continue to raise the same concerns that have been expressed about the news media since the 1970s. In focus group research, stakeholders from these communities expressed concern about their continuing under-representation or omission from the news media. They felt that voices, experiences, perspectives and issues from their communities rarely appeared, or if they did appear, it was in limited contexts – often in circumstances that portrayed them as vulnerable or disruptive. They also pointed to ongoing media misrepresentation, such as stereotyping, inappropriate framing, and over-reliance on ‘usual suspects’ to talk about their communities. A common theme that they voiced was their need for greater inclusiveness in the media. Participants wished that journalists would better represent the diversity of life experiences and perspectives within their communities. Stakeholders also wanted an increased in representation of their political frameworks, such as stories about the difficulties they encountered in dealing with social and bureaucratic systems, and their understandings of causes and potential solutions for issues affecting their communities.

Private lawyers in contemporary society : Australia

Admission to practice law in Australia falls under the general supervisory power of supreme court judges in the various jurisdictions. The degree of supervision varies among jurisdictions, but the judiciary generally is responsible for setting the educational requirements for admission. A variety of admission boards perform a number of administrative and supervisory functions; for example, determining whether a particular law school's degree satisfies educational requirements for admission...

Process mining for clinical processes: A comparative analysis of four Australian hospitals

Business process analysis and process mining, particularly within the health care domain, remain under-utilised. Applied research that employs such techniques to routinely collected, health care data enables stakeholders to empirically investigate care as it is delivered by different health providers. However, cross-organisational mining and the comparative analysis of processes present a set of unique challenges in terms of ensuring population and activity comparability, visualising the mined models and interpreting the results. Without addressing these issues, health providers will find it difficult to use process mining insights, and the potential benefits of evidence-based process improvement within health will remain unrealised. In this paper, we present a brief introduction on the nature of health care processes; a review of the process mining in health literature; and a case study conducted to explore and learn how health care data, and cross-organisational comparisons with process mining techniques may be approached. The case study applies process mining techniques to administrative and clinical data for patients who present with chest pain symptoms at one of four public hospitals in South Australia. We demonstrate an approach that provides detailed insights into clinical (quality of patient health) and fiscal (hospital budget) pressures in health care practice. We conclude by discussing the key lessons learned from our experience in conducting business process analysis and process mining based on the data from four different hospitals.

Are we there yet?

The political and bureaucratic discourse surrounding non-profit sector reform is centred on streamlining the regulatory framework. Phrases such as 'one-stop shop','reducing red tape' and 'duplicative, burdensome and unclear requirements' fill press releases, government reports and discussion papers. In this chapter, I examine quantitative measures of the current regulatory compliance burden facing non-profit organisations in Australia as a benchmark for measuring progress over the coming years. I focus on regulatory compliance estimates for four key stages of non-profit enterprise activity non-profit enterprise start-up and registrations; fundraising;grant paperwork; and regulation proportionate to the size of the non-profit enterprise.

Exploring Environmental Stewardship Through Data-Driven Practices

What potential do artists working with environmental data in public space have for producing new forms of engagement with local environmental conditions? Operating on the edge of heavy bureaucracy, these types of data-driven artistic experiments probe the politics of environmental metrics and explore methods of engaging audiences with issues of environmental health. This discussion considers a small collection of cases studies representative of this growing field of practice. These are works by Natalie Jeremijenko and The Living, Tega Brain and Keith Deverell. The case studies considered are examples of strategic design, works that soften, reveal and potentially shift existing regulations and bureaucratic norms. In doing so they open up new possibilities and questions as to what the smart city is and how it might be realised.

Commonwealth government agency libraries review: Literature review

Ongoing financial, administrative, and technological changes present significant challenges and opportunities for government libraries in delivering services to their clients. Determining how government library and information services might best confront these challenges and take advantage of new opportunities is crucial for the future of the sector. The Australian Government Libraries Information Network (AGLIN) has commissioned a review of service delivery models in Commonwealth Government libraries. As an initial step in the project, a literature review was undertaken in order to consider the issues which impact directly on government library service provision today. The literature review builds on and updates the review prepared for the Queensland Government Agency Libraries Review (QGALR) five years ago.

Adaptation of Sudanese refugees in an Australian context : investigating helps and hindrances

The present study investigates the experiences of Sudanese refugees by exploring the themes that characterise participants’ experiences in Sudan, en route, and at their Australian destination. In particular, the research identifies several factors that may be seen as ‘helps’ or ‘hindrances’ to Sudanese refugees’ adaptation. Participants were 12 Sudanese refugees aged between 19 and 40 years who had been residing in Australia for five years or less. A qualitative phenomenological approach to data collection and analysis was employed. Examination of the interview transcripts revealed that all participants identified both ‘hindrances’ and ‘helps’ toward adaptation and indicated that positive adaptation is not only possible, but probable for Sudanese refugees in spite of their past experiences of trauma and present resettlement difficulties. Several practical implications were elicited from the research including a need for programs that actively promote refugees’ adaptation by encouraging the broadening of social networks.

Do Australian public and nonprofit nurses cope with administrative stressors?

The nursing profession in Australia and other OECD countries such as the USA and the UK, have focused on ways to recruit and retain nurses (e.g., Bartram, Joiner, & Stanton, 2004). Research has shown that the most common factors impacting negatively on retention include sources of nursing stress such as workload and work environment. While the literature has shown that nursing staff encounter these stressors, studies do not examine the effects of stress caused by an increasing degree of administrative demand placed on nurses, caused by the new public management (NPM) reform in public and nonprofit (PNP) health care organizations. At best, some studies have alluded to some aspects of administrative related stressors (vis-a-vis nursing related stressors such as death, sickness, etc), but they have not been examined in any detail. Similarly, extant research has not examined how nurses cope with these administrative stressors. These will be the main aims of the present study.