Community development and enterprise culture : prospects and dilemmas

Community Development as a form of practice promotes empowerment and social justice. Its origins lie in people's collective struggle to be heard, recognised and accorded full citizenship in society. It has developed strategies to achieve social change that challenge dominant ways of thinking, policy and resource allocation in society. 'Enterprise culture has its origins in the individualism and competitiveness of capitalism. These essentially neo-liberalist concepts have been remoulded into a radical political program of change sponsored by the state under the guise of new managerialism, competitive tendering and privatization. This research seeks to examine the interface between community development and enterprise culture as a potential site of tension and contestation through an analysis of discourse. The initial task, therefore, was to elaborate the concept of enterprise culture and examine the ways enterprise culture has been manifested in community development. The focus has been on practitioners committed to community development through a qualitative, empirical approach with a view to discerning their views on the relevance and impact of enterprise culture on their work. Community development provides a useful domain for interrogating the infiltration of the concept of the enterprise culture because of its history of opposition and mobilisation. The research seeks to understand the ways in which the forms of enterprise culture as an essentially cultural project are manifested in practice contexts and to analyse the nature of the response to its various manifestations. As a result, it constitutes more than just a critique of any one of these forms, eg, privatisation, tendering out, managerialism, and instead seeks to investigate the degree to which a cultural shift may be occurring towards notions of greater individualism and away from collective notions of responsibility, obligation and citizenship. The research critically analyses the impact of enterprise culture on Australian social policy through the case study of community development practice. The manifestations of enterprise culture are investigated at various levels, with an emphasis on the responses of practitioners. A related aim is to reveal the range of possible responses to the infiltration of the enterprise culture in terms of values, language and practice into community development. Are new forms of practice emerging or is the field being steadily co-opted by government social and educational policy? Finally, the research should enable some future directions to be identified for the field of community development. The findings represent an initial attempt in an Australian context to establish the degree of influence that enterprise culture has had and/or will have on social policy. Chapter 1 examines the concept of enterprise culture and a background to its impact on community development as a domain of practice. The meaning of enterprise culture and its origins will be examined in Chapter 2. Its influence on Australian social policy is then discussed with particular reference to recent changes in Victoria regarding family services. In Chapter 3, the main features of critical discourse analysis are outlined as a framework for subsequent analysis of the links between discourse and hegemony. The work of Fairclough (1992, 1995) is utilised to highlight the relevance of discourse analysis to an examination of the infiltration of ideas associated with enterprise culture into the domain of community development. Chapter 4 provides an overview of the origins and defining characteristics of community development practice. The diverse beginnings and philosophical underpinnings are discussed and the main features of community development outlined in order to establish meanings attached to key concepts such as empowerment and participation. In Chapter 5, the findings of initial interviews with sixteen community development practitioners are discussed in terms of their perceptions of the impact of enterprise culture on their practice and the organisational culture within which they operate. These initial interviews were conducted in November-December 1996. A primary focus of the interviews was to establish the key words in their lexicon of practice and to provide an opportunity for reflection on the relative influence of discourse and practices associated with enterprise culture. A framework for analysing and making sense of the forms of response to enterprise culture is applied to the responses. Four forms of possible response are proposed and discussed in the context of the data. Follow up interviews were conducted in November-December 1997 and the findings of these interviews are discussed in Chapter 6. A particular emphasis in these interviews was on any changes in the lexicon of practice and indications of a change in the impact of discourse and practices associated with enterprise culture. The forms of response suggested in the framework outlined in Chapter 5 are discussed in the light of any movement in the responses of participants in the study. The implications of the findings are discussed in the context of the framework of responses or forms of embrace of enterprise culture analysed in earlier chapters. Finally, in Chapter 7, the potential for community development as a form of practice to transcend or at least accommodate the impact of enterprise culture through strategic forms of embrace is discussed and possible strategies based on the research that may assist in the development of this response are proposed.

Just call me dad: health and social benefits to fathers and their children

In the past 20 years, social change and expectations for both maternal and paternal responsibilities have highlighted the need for services for families to better understand the role of a father in family relationships. In Australia, as well as internationally, there have been many contested understandings about what constitutes ‘good fathering’ in research, social media and in the political sphere. More specifically, there has also been an emerging trend to understand the challenging task of recruiting and maintaining men's involvement in child and family services programmes, particularly those fathers who are deemed a risk to children and mothers, violent or have been separated from their children. That many child and family/welfare services have exercised dedicated effort to work with fathers is still a relatively recent phenomenon, and has only emerged following criticism that services have been too geared towards working only with mothers. Despite this increasing interest, there is still ongoing need for more research to be undertaken in Australia. An important area of focus is the views of professionals about their perception and engagement of fathers, particularly the views of fathers who are described as being absent from family-based services. The purpose of this article is to report briefly on a study undertaken to examine how child and family welfare workers engage fathers in their work. First, this paper will describe some of the social and health benefits to fathers and their children, focusing on the key role of attachment through play. Research into effective service delivery involving fathers will then be presented, concluding with key practice factors necessary for fathers to be involved in family life.

What about the men? Gender differences in utilisation of arthritis self-management services

As self-management programs for chronic illness increasingly become the domain of primary health care providers, it is important to consider gender inequities in access to these services and gender differences in patterns of use to inform the development and delivery of services. This study explores gender differences in levels and patterns of access to arthritis elf-management services by analyzing data collected from the Telephone Information Service of Arthritis Victoria, Contingency tables were analyzed and odds-ratios calculated to confirm gender differences in levels and patterns of service utilisation. Men were found to be significantly under-represented as users of the service, even after taking into account gender differences in prevalence of arthritis in the population. Women were more likely than men to contact the service on their own behalf. Men were more likely to have a family member or friend contact the services for them. Women showed more interest in learning about their condition while men focused more on symptom management. These gender differences in rates and patterns of services use indicate that services providers of self-management services for conditions such as arthritis need to take into account the interaction between gender and service utilisation.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Managing the family`s health: preferences and experiences of women with different work and family arrangements.

Balancing the needs of work and family is a subject of much debate.The purpose of this research was to explore how families manage their children's health within the context of different work and family arrangements.In-depth interviews were conducted with women who were at home full time (8) or in paid work over 30 hours a week (7). Women had at least one child under the five years of age. Findings revealed there was no simple relationship between women's working arrangements and how they managed their children's health. All women, irrespective of their working arrangements, held similar preferences for managing their children's health.However, most women experienced either time or financial constraints that meant they had to compromise their original preferences. In some cases this meant children missed out on receiving health services. Workplace support, extended family support and general satisfaction with work and family arrangements appeared to be important factors for the small number of women who had no problems in managing their children's health. The implications of these findings are discussed.

Not the same : a comparison of female and male clients seeking treatment from problem gambling counselling services

Previous studies of problem gamblers portray this group as being almost exclusively male. However, this study demonstrates that females comprised 46% of the population (n = 1,520) of persons who sought assistance due to concerns about their gambling from the publicly-funded BreakEven counselling services in the state of Victoria, Australia, in one 12-month period. This suggests that the model of service delivery which is community based counselling on a non-residential basis may be better able to attract female clients than treatment centres where males predominate such as veterans centres. A comparative analysis of the social and demographic characteristics of female and male gamblers within the study population was undertaken. As with previous studies, we have found significant differences between males and females who have sought help for problems associated with their gambling. Gender differences revealed in this study include females being far more likely to use electronic gaming machines (91.1% vs. 61.4%), older (39.6 years vs. 36.1 years), more likely to be born in Australia (79.4% vs. 74.7%), to be married (42.8% vs. 30.2%), living with family (78.9% vs. 61.5%) and to have dependent children (48.4% vs. 35.7%), than males who present at these services. Female gamblers (A$7,342) reported average gambling debts of less than half of that owed by males (A$19,091). These gender differences have implications for the development and conduct of problem gambling counselling services as it cannot be assumed that models of service which have demonstrated effectiveness with males will be similarly effective with females.

Priorities for Australian family businesses

This paper reports on a national survey which identified priorities that are considered important to the success of Australian family businesses. The FBA and KPMG Family Business Needs Survey 2005 targeted organisations of all sizes and industries across all states. Findings from the survey are extensive and provide noteworthy progress in understanding the issues deemed most important to family businesses, such as balancing family concerns and business interests, balancing short-term and long-term business decisions and increasing profits. As a result of this project, it has: provided an instrument that will allow research investigation on an annual basis; provided initial data sets that highlight key issues facing family business survival; and provided a substantial data set that can be utilised by a range of researchers and practitioners.

Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health

The aim of the research was to identify factors related to the increased costs of providing health services to clients from a non-English speaking background (NESB), using a cross-sectional analysis of the administrative records of clients using community health services in the Northern Metropolitan region of Melbourne for the 2001/2002 financial year. The higher cost of providing services to NESB clients was influenced by four factors: increased consultation time, group attendance to an appointment, increased interpreting costs and the type of service provider. Family members and multilingual staff play a significant role in providing informal interpreting services or low-cost support for NESB consultants, and these activities should receive appropriate support. Additional funding is needed to support interpreting requirements when dealing with the health needs of NESB clients.

Parenting a preterm infant: experiences in a regional neonatal health services programme

In an Australian regional health service, parents’ experiences of the neonatal intensive care (NICU), neonatal nurseries and a community discharge programme were investigated. Parents from 12 families participated in an in-depth interview. Three themes captured a partial, yet significant, view of these parents’ experiences as they strived to develop their identity and competence as parents. The findings are explored as they reveal issues associated with the provision of family centred, developmental care in neonatal services. Opportunities for nurses in this context to expand and clarify their role in ways that are responsive to parenting needs are discussed.

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.

The decision-making journey of a family carer : information and social needs in a cultural context

While the important role of family as carer has been increasingly recognised in healthcare service provision, particularly for patients with acute or chronic illnesses, the carer's information and social needs have not been well understood and adequately supported. In order to provide continuous and home-based care for the patient, and to make informed decisions about the care, a family carer needs sufficient access to medical information in general, the patient's health information specifically, and supportive care services. Two key challenges are the carer's lack of medical knowledge and the many carers with non-English speaking and different cultural backgrounds. The informational and social needs of family carers are not yet well understood. This paper analyses the web-log of a husband-carer who provided support for his wife, who at the time of care was a lung cancer patient. It examines the decision-making journey of the carer and identifies the key issues faced in terms of informational and social practices surrounding care provision.