A socially responsible model of micro-credit delivery to support sustainable community development in emerging economies

Micro-finance, which includes micro-credit as one of its core services, has become an important component of a range of business models – from those that operate on a strictly economic basis to those that come from a philanthropic base, through Non Government Organisations (NGOs). Its success is often measured by the number of loans issued, their size, and the repayment rates. This paper has a dual purpose: to identify whether the models currently used to deliver micro-credit services to the poor are socially responsible and to suggest a new model of delivery that addresses some of the social responsibility issues, while supporting community development. The proposed model is currently being implemented in Beira, the second largest city in Mozambique. Mozambique exhibits many of the characteristics found in other African countries so the model, if successful, may have implications for other poor African nations as well as other developing economies.

Ethical dilemmas : a model to understand teacher practice

Over recent decades, the field of ethics has been the focus of increasing attention in teaching. This is not surprising given that teaching is a moral activity that is heavily values-laden. Because of this, teachers face ethical dilemmas in the course of their daily work. This paper presents an ethical decision-making model that helps to explain the decision-making processes that individuals or groups are likely to experience when confronted by an ethical dilemma. In order to make sense of the model, we put forward three short ethical dilemma scenarios facing teachers and apply the model to interpret them. Here we identify the critical incident, the forces at play that help to illuminate the incident, the choices confronting the individual and the implications of these choices for the individual, organization and community. Based on our analysis and the wider literature we identify several strategies that may help to minimize the impact of ethical dilemmas. These include the importance of sharing dilemmas with trusted others; having institutional structures in schools that lessen the emergence of harmful actions occurring; the necessity for individual teachers to articulate their own personal and professional ethics; acknowledging that dilemmas have multiple forces at play; the need to educate colleagues about specific issues; and the necessity of appropriate preparation and support for teachers. Of these strategies, providing support for teachers via professional development is explored more fully.

Religious information literacy : using information to learn in church community

What informs members of the church community as they learn? Do the ways people engage with information differ according to the circumstances in which they learn? Informed learning, or the ways in which people use information in the learning experience and the degree to which they are aware of that, has become a focus of contemporary information literacy research. This essay explores the nature of informed learning in the context of the church as a learning community. It is anticipated that insights resulting from this exploration may help church organisations, church leaders and lay people to consider how information can be used to grow faith, develop relationships, manage the church and respond to religious knowledge, which support the pursuit of spiritual wellness and the cultivation of lifelong learning. Information professionals within the church community and the broader information profession are encouraged to foster their awareness of the impact that engagement with information has in the learning experience and in the prioritising of lifelong learning in community contexts.

Post-disaster housing reconstruction : challenges for community participation

The extant literature suggests that community participation is an important ingredient for the successful delivery of post-disaster housing reconstruction projects. Even though policy-makers, international funding bodies and non-governmental organisations broadly appreciate the value of community participation, post-disaster reconstruction practices systematically fail to follow, or align with, existing policy statements. Research into past experiences has led many authors to argue that post-disaster reconstruction is the least successful physically visible arena of international cooperation. Why is the principle of community participation not evident in the veracity of reconstructions already carried out on the ground? This paper discusses and develops the concepts of, and challenges to, community participation and the subsequent negative and positive effects on post-disaster reconstruction projects outcomes.

A trial of the distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies

We explored the feasibility of community pharmacies for the distribution of chlamydia specimen self-collection kits, which featured a transport medium allowing postage of urine specimens in Australia. Eligible clients were requested to complete a code-matched risk-screening questionnaire in the pharmacy, and the derived risk scores were compared to the test results from the corresponding specimen. Four Queensland pharmacies distributed 156 kits, while 44 questionnaires and 18 specimens were received.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Conveyancing alert

Significant amendments to the Property Agents and Motor Dealers Act 2000 (Qld) (‘PAMDA’) and the Body Corporate and Community Management Act 1997 (Qld) (‘BCCMA’) were made by the Liquor and Other Acts Amendment Act 2005 (Qld). These amendments commenced on 1 December 2005. The purpose of this alert is to very briefly describe the amendments and to indicate certain issues that may arise. The alert is intended to signal the need for careful perusal of these amendments.

48 Hour Game Making Challenge - In Progress [Four Episodes]

Statement: Jams, Jelly Beans and the Fruits of Passion Let us search, instead, for an epistemology of practice implicit in the artistic, intuitive processes which some practitioners do bring to situations of uncertainty, instability, uniqueness, and value conflict. (Schön 1983, p40) Game On was born out of the idea of creative community; finding, networking, supporting and inspiring the people behind the face of an industry, those in the mist of the machine and those intending to join. We understood this moment to be a pivotal opportunity to nurture a new emerging form of game making, in an era of change, where the old industry models were proving to be unsustainable. As soon as we started putting people into a room under pressure, to make something in 48hrs, a whole pile of evolutionary creative responses emerged. People refashioned their craft in a moment of intense creativity that demanded different ways of working, an adaptive approach to the craft of making games – small – fast – indie. An event like the 48hrs forces participants’ attention on the process as much as the outcome. As one game industry professional taking part in a challenge for the first time observed: there are three paths in the genesis from idea to finished work: the path that focuses on mechanics; the path that focuses on team structure and roles and the path that focuses on the idea, the spirit – and the more successful teams need to put the spirit of the work first and foremost. The spirit drives the adaptation, it becomes improvisation. As Schön says: “Improvisation consists on varying, combining and recombining a set of figures within the schema which bounds and gives coherence to the performance.” (1983, p55). This improvisational approach is all about those making the games: the people and the principles of their creative process. This documentation evidences the intensity of their passion, determination and the shit that they are prepared to put themselves through to achieve their goal – to win a cup full of jellybeans and make a working game in 48hrs. 48hr is a project where, on all levels, analogue meets digital. This concept was further explored through the documentation process. This set of four videos were created by Cameron Owen on the fly during the challenge using both the iphone video camera and editing software in order to be available with immediacy and allow the event audience to share the experience - and perhaps to give some insights into the creative process exposed by the 48 hour challenge. ____________________________ Schön, D. A. 1983, The Reflective Practitioner: How Professionals Think in Action, Basic Books, New York

Online we are all able bodied : Online psychological sense of community and social support found through membership of disability-specific websites promotes well-being for people living with a physical disability

People with a physical disability are a population who for a number of reasons may be vulnerable to social isolation. Research into Internet-based support sites has found that social support and an online sense of community can be developed through computer mediated communication channels. This study aims to gain an understanding of the benefits that membership of disability-specific online communities may have for people with a physical disability. An online survey was administered to a sample of users of such sites (N = 160). Results indicated that users did receive moral support and personal advice through participating in such online communities. Further, results indicated that online social support and feeling a sense of community online were positively associated with participants' well-being in the areas of personal relations and personal growth.

Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Background Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model. Methods Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call. Results The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care. Conclusions Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Review of refugee mental health interventions following resettlement : best practices and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Maximum recovery after knee replacement - the MARKER study rationale and protocol

Background There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes. Methods/Design In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery. Discussion The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.

A sustainable approach to community based rehabilitation in rural and remote Australia

This paper presents a summary of an extensive review of the health, disability and rehabilitation literature conducted for the purposes of informing the formulation of a sustainable approach to community based rehabilitation in rural and remote Australia. It begins with a review of definitions of disability and rehabilitation, which is followed by differentiating 'rehabilitation in the community' and 'community based rehabilitation'. Finally, a network of community based rehabilitation coalitions is proposed as a sustainable approach to community based rehabilitation in rural and remote Australia. Each coalition would have a community rehabilitation facilitator and community specific database of resources, as well as a register of local community rehabilitation assistants who can support the work of health professionals by providing rehabilitation interventions under the latter's direction. In this approach, rehabilitation is conceptualised as being about people's lives rather than only a series of interventions provided by health care professionals. As such, rehabilitation becomes everybody's business.

The impact of rhetoric and reality on community anticipation of risk in the development of multi-purpose services (MPS) : A grounded theory study

better health service.Conclusion:This research provides an insight into the perceptions of the rhetoric and reality of community member involvement in the process of developing multi-purpose services. It revealed a grounded theory in which fear and trust were intrinsic to a process of changing from a traditional hospital service to the acceptance of a new model of health care provided at a multi-purpose service.