Academic literature on the topic 'Interdepartmental Coordinating Council on Community Services'

ObjectiveThrough opioid overdose surveillance data briefs, we aim to focus on creating meaningful targeted reports that incorporate mindful “data points” and visualizations for diverse audiences. Data briefs provide information that is actionable to support decision making across the spectrum of partners involved in responding to Tennessee’s opioid epidemic. Additionally, visualizations and reporting of opioid overdose surveillance data create pathways and processes for sharing data and opportunities to collaborate with others’ expertise that enrich communication among multi agency collaborators and interdepartmental partners.IntroductionTennessee has experienced an increase of fatal and non-fatal drug overdoses which has been almost entirely driven by the opioid epidemic1. Increased awareness by medical professionals, new legislation surrounding prescribing practices, and mandatory use of the state’s prescription drug monitoring program has resulted in a decrease of opioid prescriptions and dosages. Paradoxically, emergency department discharges and inpatient hospitalizations due to opioid overdoses have continued to increase. The Tennessee Department of Health, Office of Informatics and Analytics (TDH OIA) has developed visualizations and reports for opioid overdose surveillance data to enhance communication and timely response by health partners. Through opioid overdose surveillance reporting data briefs we aim to focus not on “big data” analytics, but rather meaningfully targeted data briefs that illustrate mindful “data points” and visualizations. These data briefs provide information that is actionable to support decision making across the spectrum of partners involved in responding to Tennessee’s opioid epidemic.MethodsTDH has partnered with state agencies including the Department of Mental Health and Substance Abuse Services (DMHSAS) and the Tennessee Bureau of Investigation (TBI) as well as internal TDH divisions to foster enhanced opioid response communication. In order to provide a comprehensive yet digestible way to share information we have created two sets of data visualizations that communicate pertinent weekly and monthly opioid overdose trends. A bi-weekly brief contains information from four data sources: Tennessee’s Controlled Substance Monitoring Database which is Tennessee’s prescription drug monitoring program (PDMP); the Drug Overdose Reporting system which contains non-fatal opioid overdoses captured in hospitals’ emergency departments; Vital Records Information System Management which captures fatal drug overdose information; and the Tennessee Incident Based Reporting System which includes opioid and heroin related arrest information. The bi-weekly data brief provides a quick yet inclusive layout of data in an easily consumable manner. A one page front and back layout is divided into four sections, representing each of the four data sources. A nonfatal opioid overdose “counter” displays a year-to-date count of non-fatal opioid overdoses as compared to the previous year.The monthly report follows a slightly different layout, as the report hones in on data pertaining only to non-fatal opioid overdoses reported from hospital emergency departments. A monthly year-to-date count of non-fatal opioid overdoses and counts of non-fatal opioid overdoses by race and age are included in the report, as well as a visualization depicting the number of non-fatal opioid overdoses by month by opioid class. The monthly report also includes a choropleth map that displays non-fatal opioid overdoses by zip code for the reporting month and a heat map of non-fatal opioid overdoses for cumulative 2018.Initial feedback from partners about the visualizations included requests to add footnotes for readers to distinguish the data sources and data limitations, as well as requests to provide enhanced contextual information such as year to date counts, previous year counts, and previous month comparisons. Further visualization discussions included requests to add public health regions as a map overlay, identifying metrics that best illuminate “red flags” or upticks in numbers, and assessing whether to display counts or rates for a given data source.ResultsData briefs and reports are disseminated to TDH leadership, the Office of the State Chief Medical Examiner, the Office of General Counsel, TBI, DMHSAS, regional epidemiologists and the newly formed Opioid Overdose Coordinating Office. These data briefs have been proven to be an effective tool for enhanced communication and responding to the opioid crisis. For example, the TDH Commissioner’s office requested additional information about a county that was consistently ranking high in non-fatal overdoses as illustrated on a data report. The dissemination of data briefs has also strengthened internal TDH partnerships including linking Viral Hepatitis and HIV programs with OIA to develop visualizations that incorporate HCV and HIV data (Hepatitis C Virus; Human Immunodeficiency Virus) with opioid overdose data to better understand and elucidate the syndemic of opioid overdose, HCV, and HIV in Tennessee.The dissemination of data briefs and reports has also been an effective tool for responding to the opioid crisis with our interagency partner, DMHSAS. A DMHSAS team utilized the data briefs to inform how and where to expand an overdose recovery navigator program within the state—a program that provides individuals who have recently overdosed (and are still in the emergency room) with information for treatment and recovery resources. Current work, also in partnership with DMHSAS, has been the creation of a data brief specifically on the topic of harm reduction. The data brief will include a map that shows areas of naloxone distribution to law enforcement agencies throughout the state, as well as a map that illustrates naloxone administration locations by law enforcement officers in the field. Additionally, information on locations of syringe exchange programs will be included in the brief. Members from DMHSAS have provided feedback that they anticipate using the harm reduction brief to assess which remaining law enforcement facilities have not yet on-boarded to receive naloxone, to pin point areas where additional distributions of naloxone might be needed, and identify where supplemental naloxone administration trainings for, either law enforcement or the community, might be targeted.ConclusionsVisualizations have illuminated patterns and “red flags” in geographic areas that have helped guide decision makers in making data-driven decisions about opioid response. Visualizations and reporting of opioid overdose surveillance data has also importantly enriched communication among multi agency collaborators and interdepartmental partners that, until now, have been largely siloed. Pathways and processes for sharing data and opportunities to collaborate with others’ expertise have been strengthened by the dissemination of targeted mindful “data point” briefs over large scale “big data” analytics.ReferencesOffice of Informatics and Analytics, Tennessee Department of Health. Prescription drug overdose program 2018 report: understanding and responding to the opioid epidemic in Tennessee using mortality, morbidity, and prescription data [Internet]. Tennessee Department of Health, 2018. Available from: https://www.tn.gov/content/dam/tn/health/documents/pdo/PDO_2018_Report_02.06.18.pdf.

Abstract Background The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services. Methods We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. Results Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). Conclusions We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.

Abstract The WHO has reported that mental health disorders are a leading cause of disability worldwide, and the gaps in access to treatment, especially in low resourced settings, are a global public health issue. Refugees and migrants are disproportionately negatively impacted by factors contributing to mental health disorders barriers to care. Although considerable advances have been made in the development of MHPSS interventions, the efficacy and sustainability of these strategies depends largely on the ability to provide effective educational and training programs preparing and incentivizing future students needed to design, implement, and deliver MHPSS services. This roundtable discussion convenes individuals working across public, private, and academic sectors to explore novel partnerships seeking to scale up and transform mental health education to support refugees and forcibly displaced migrants. Panelists will discuss multi sector and institutional collaborations are needed to address such large-scale mental health gaps. In addition, this panel will discuss recent projects expanding curricular development, educational and research partnerships, and the development of pedagogical tools for professionals working in the mental health field, undergraduate and graduate students, faculty, and community partners. Anne Jachmann, a member of the Migration and Medicine research division of the Emergency Department of the University of Bern, has been studying and development of new practices to reduce barriers to diagnosis and the development of early interventions for asylum seekers in the Emergency Room. Adam Brown is a Clinical Psychologist and Director of the Trauma and Global Mental Health Lab. He will be discussing new initiatives and partnership in New York City and Latin America to scale up clinical treatment and research capacity for refugee and immigrant communities. Maria Hoen is a Historian and the Principal Investigator of the Consortium for Forced Migration, Displacement, and Education, a network of universities and colleges that has been developing novel educational strategies for refugee students and scholars as well as those working in this context. Nicole Shea is the Director of the Council for European Studies and the Executive Editor of EuropeNow, a global publication for a broad, multi-disciplinary educated audience. She will discuss how findings disseminated by media outlets on mental health and migration are critical for shaping discourse, education, and policy. Finally, Kyle Farmbry, Principal Investigator of the University Alliance for Refugees and At-Risk Migrants will provide insights on how a group of researchers, practitioners, and policymaker are coordinating efforts to harness the potential of university communities for the empowerment and protection of refugees and at-risk migrants. A discussion with audience will follow the panelists presentations. Key messages This panel will explore ways mental health education and training may better address the needs of refugees and migrants, through promoting interdisciplinary collaborations. Discuss ways for interdisciplinary partnerships and multi-institutional collaborations to provide comprehensive and dynamic training opportunities in forced migration mental health care.

Introduction I think the Privacy Act is a huge edifice to protect the minority of things that could go wrong. I’ve got a good example for you, I’m just trying to think … yeah the worst one I’ve ever seen was the Balga Youth Program where we took these students on a reward excursion all the way to Fremantle and suddenly this very alienated kid started to jump under a bus, a moving bus so the kid had to be restrained. The cops from Fremantle arrived because all the very good people in Fremantle were alarmed at these grown-ups manhandling a kid and what had happened is that DCD [Department of Community Development] had dropped him into the program but hadn’t told us that this kid had suicide tendencies. No, it’s just chronically bad. And there were caseworkers involved and … there is some information that we have to have that doesn’t get handed down. Rather than a blanket rule that everything’s confidential coming from them to us, and that was a real live situation, and you imagine how we’re trying to handle it, we had taxis going from Balga to Fremantle to get staff involved and we only had to know what to watch out for and we probably could have … well what you would have done is not gone on the excursion I suppose (School Principal, quoted in Balnaves and Luca 49). These comments are from a school principal in Perth, Western Australia in a school that is concerned with “at-risk” students, and in a context where the Commonwealth Privacy Act 1988 has imposed limitations on their work. Under this Act it is illegal to pass health, personal or sensitive information concerning an individual on to other people. In the story cited above the Department of Community Development personnel were apparently protecting the student’s “negative right”, that is, “freedom from” interference by others. On the other hand, the principal’s assertion that such information should be shared is potentially a “positive right” because it could cause something to be done in that person’s or society’s interests. Balnaves and Luca noted that positive and negative rights have complex philosophical underpinnings, and they inform much of how we operate in everyday life and of the dilemmas that arise (49). For example, a ban on euthanasia or the “assisted suicide” of a terminally ill person can be a “positive right” because it is considered to be in the best interests of society in general. However, physicians who tacitly approve a patient’s right to end their lives with a lethal dose by legally prescribed dose of medication could be perceived as protecting the patient’s “negative right” as a “freedom from” interference by others. While acknowledging the merits of collaboration between people who are working to improve the wellbeing of students “at-risk”, this paper examines some of the barriers to collaboration. Based on both primary and secondary sources, and particularly on oral testimonies, the paper highlights the tension between privacy as a negative right and collaborative helping as a positive right. It also points to other difficulties and dilemmas within and between the institutions engaged in this joint undertaking. The authors acknowledge Michel Foucault’s contention that discourse is power. The discourse on privacy and the sharing of information in modern societies suggests that privacy is a negative right that gives freedom from bureaucratic interference and protects the individual. However, arguably, collaboration between agencies that are working to support individuals “at-risk” requires a measured relaxation of the requirements of this negative right. Children and young people “at-risk” are a case in point. Towards Collaboration From a series of interviews conducted in 2004, the school authorities at Balga Senior High School and Midvale Primary School, people working for the Western Australian departments of Community Development, Justice, and Education and Training in Western Australia, and academics at the Edith Cowan and Curtin universities, who are working to improve the wellbeing of students “at-risk” as part of an Australian Research Council (ARC) project called Smart Communities, have identified students “at-risk” as individuals who have behavioural problems and little motivation, who are alienated and possibly violent or angry, who under-perform in the classroom and have begun to truant. They noted also that students “at-risk” often suffer from poor health, lack of food and medication, are victims of unwanted pregnancies, and are engaged in antisocial and illegal behaviour such as stealing cars and substance abuse. These students are also often subject to domestic violence (parents on drugs or alcohol), family separation, and homelessness. Some are depressed or suicidal. Sometimes cultural factors contribute to students being regarded as “at-risk”. For example, a social worker in the Smart Communities project stated: Cultural factors sometimes come into that as well … like with some Muslim families … they can flog their daughter or their son, usually the daughter … so cultural factors can create a risk. Research elsewhere has revealed that those children between the ages of 11-17 who have been subjected to bullying at school or physical or sexual abuse at home and who have threatened and/or harmed another person or suicidal are “high-risk” youths (Farmer 4). In an attempt to bring about a positive change in these alienated or “at-risk” adolescents, Balga Senior High School has developed several programs such as the Youth Parents Program, Swan Nyunger Sports Education program, Intensive English Centre, and lower secondary mainstream program. The Midvale Primary School has provided services such as counsellors, Aboriginal child protection workers, and Aboriginal police liaison officers for these “at-risk” students. On the other hand, the Department of Community Development (DCD) has provided services to parents and caregivers for children up to 18 years. Academics from Edith Cowan and Curtin universities are engaged in gathering the life stories of these “at-risk” students. One aspect of this research entails the students writing their life stories in a secured web portal that the universities have developed. The researchers believe that by engaging the students in these self-exploration activities, they (the students) would develop a more hopeful outlook on life. Though all agencies and educational institutions involved in this collaborative project are working for the well-being of the children “at-risk”, the Privacy Act forbids the authorities from sharing information about them. A school psychologist expressed concern over the Privacy Act: When the Juvenile Justice Department want to reintroduce a student into a school, we can’t find out anything about this student so we can’t do any preplanning. They want to give the student a fresh start, so there’s always that tension … eventually everyone overcomes [this] because you realise that the student has to come to the school and has to be engaged. Of course, the manner and consequences of a student’s engagement in school cannot be predicted. In the scenario described above students may have been given a fair chance to reform themselves, which is their positive right but if they turn out to be at “high risk” it would appear that the Juvenile Department protected the negative right of the students by supporting “freedom from” interference by others. Likewise, a school health nurse in the project considered confidentiality or the Privacy Act an important factor in the security of the student “at-risk”: I was trying to think about this kid who’s one of the children who has been sexually abused, who’s a client of DCD, and I guess if police got involved there and wanted to know details and DCD didn’t want to give that information out then I’d guess I’d say to the police “Well no, you’ll have to talk to the parents about getting further information.” I guess that way, recognising these students are minor and that they are very vulnerable, their information … where it’s going, where is it leading? Who wants to know? Where will it be stored? What will be the outcomes in the future for this kid? As a 14 year old, if they’re reckless and get into things, you know, do they get a black record against them by the time they’re 19? What will that information be used for if it’s disclosed? So I guess I become an advocate for the student in that way? Thus the nurse considers a sexually abused child should not be identified. It is a positive right in the interest of the person. Once again, though, if the student turns out to be at “high risk” or suicidal, then it would appear that the nurse was protecting the youth’s negative right—“freedom from” interference by others. Since collaboration is a positive right and aims at the students’ welfare, the workable solution to prevent the students from suicide would be to develop inter-agency trust and to share vital information about “high-risk” students. Dilemmas of Collaboration Some recent cases of the deaths of young non-Caucasian girls in Western countries, either because of the implications of the Privacy Act or due to a lack of efficient and effective communication and coordination amongst agencies, have raised debates on effective child protection. For example, the British Laming report (2003) found that Victoria Climbié, a young African girl, was sent by her parents to her aunt in Britain in order to obtain a good education and was murdered by her aunt and aunt’s boyfriend. However, the risk that she could be harmed was widely known. The girl’s problems were known to 6 local authorities, 3 housing authorities, 4 social services, 2 child protection teams, and the police, the local church, and the hospital, but not to the education authorities. According to the Laming Report, her death could have been prevented if there had been inter-agency sharing of information and appropriate evaluation (Balnaves and Luca 49). The agencies had supported the negative rights of the young girl’s “freedom from” interference by others, but at the cost of her life. Perhaps Victoria’s racial background may have contributed to the concealment of information and added to her disadvantaged position. Similarly, in Western Australia, the Gordon Inquiry into the death of Susan Taylor, a 15 year old girl Aboriginal girl at the Swan Nyungah Community, found that in her short life this girl had encountered sexual violation, violence, and the ravages of alcohol and substance abuse. The Gordon Inquiry reported: Although up to thirteen different agencies were involved in providing services to Susan Taylor and her family, the D[epartment] of C[ommunity] D[evelopment] stated they were unaware of “all the services being provided by each agency” and there was a lack of clarity as to a “lead coordinating agency” (Gordon et al. quoted in Scott 45). In this case too, multiple factors—domestic, racial, and the Privacy Act—may have led to Susan Taylor’s tragic end. In the United Kingdom, Harry Ferguson noted that when a child is reported to be “at-risk” from domestic incidents, they can suffer further harm because of their family’s concealment (204). Ferguson’s study showed that in 11 per cent of the 319 case sample, children were known to be re-harmed within a year of initial referral. Sometimes, the parents apply a veil of secrecy around themselves and their children by resisting or avoiding services. In such cases the collaborative efforts of the agencies and education may be thwarted. Lack of cultural education among teachers, youth workers, and agencies could also put the “at-risk” cultural minorities into a high risk category. For example, an “at-risk” Muslim student may not be willing to share personal experiences with the school or agencies because of religious sensitivities. This happened in the UK when Khadji Rouf was abused by her father, a Bangladeshi. Rouf’s mother, a white woman, and her female cousin from Bangladesh, both supported Rouf when she finally disclosed that she had been sexually abused for over eight years. After group therapy, Rouf stated that she was able to accept her identity and to call herself proudly “mixed race”, whereas she rejected the Asian part of herself because it represented her father. Other Asian girls and young women in this study reported that they could not disclose their abuse to white teachers or social workers because of the feeling that they would be “letting down their race or their Muslim culture” (Rouf 113). The marginalisation of many Muslim Australians both in the job market and in society is long standing. For example, in 1996 and again in 2001 the Muslim unemployment rate was three times higher than the national total (Australian Bureau of Statistics). But since the 9/11 tragedy and Bali bombings visible Muslims, such as women wearing hijabs (headscarves), have sometimes been verbally and physically abused and called ‘terrorists’ by some members of the wider community (Dreher 13). The Howard government’s new anti-terrorism legislation and the surveillance hotline ‘Be alert not alarmed’ has further marginalised some Muslims. Some politicians have also linked Muslim asylum seekers with terrorists (Kabir 303), which inevitably has led Muslim “at-risk” refugee students to withdraw from school support such as counselling. Under these circumstances, Muslim “at-risk” students and their parents may prefer to maintain a low profile rather than engage with agencies. In this case, arguably, federal government politics have exacerbated the barriers to collaboration. It appears that unfamiliarity with Muslim culture is not confined to mainstream Australians. For example, an Aboriginal liaison police officer engaged in the Smart Communities project in Western Australia had this to say about Muslim youths “at-risk”: Different laws and stuff from different countries and they’re coming in and sort of thinking that they can bring their own laws and religions and stuff … and when I say religions there’s laws within their religions as well that they don’t seem to understand that with Australia and our laws. Such generalised misperceptions of Muslim youths “at-risk” would further alienate them, thus causing a major hindrance to collaboration. The “at-risk” factors associated with Aboriginal youths have historical connections. Research findings have revealed that indigenous youths aged between 10-16 years constitute a vast majority in all Australian States’ juvenile detention centres. This over-representation is widely recognised as associated with the nature of European colonisation, and is inter-related with poverty, marginalisation and racial discrimination (Watson et al. 404). Like the Muslims, their unemployment rate was three times higher than the national total in 2001 (ABS). However, in 1998 it was estimated that suicide rates among Indigenous peoples were at least 40 per cent higher than national average (National Advisory Council for Youth Suicide Prevention, quoted in Elliot-Farrelly 2). Although the wider community’s unemployment rate is much lower than the Aboriginals and the Muslims, the “at-risk” factors of mainstream Australian youths are often associated with dysfunctional families, high conflict, low-cohesive families, high levels of harsh parental discipline, high levels of victimisation by peers, and high behavioural inhibition (Watson et al. 404). The Macquarie Fields riots in 2005 revealed the existence of “White” underclass and “at-risk” people in Sydney. Macquarie Fields’ unemployment rate was more than twice the national average. Children growing up in this suburb are at greater risk of being involved in crime (The Age). Thus small pockets of mainstream underclass youngsters also require collaborative attention. In Western Australia people working on the Smart Communities project identified that lack of resources can be a hindrance to collaboration for all sectors. As one social worker commented: “government agencies are hierarchical systems and lack resources”. They went on to say that in their department they can not give “at-risk” youngsters financial assistance in times of crisis: We had a petty cash box which has got about 40 bucks in it and sometimes in an emergency we might give a customer a couple of dollars but that’s all we can do, we can’t give them any larger amount. We have bus/metro rail passes, that’s the only thing that we’ve actually got. A youth worker in Smart Communities commented that a lot of uncertainty is involved with young people “at-risk”. They said that there are only a few paid workers in their field who are supported and assisted by “a pool of volunteers”. Because the latter give their time voluntarily they are under no obligation to be constant in their attendance, so the number of available helpers can easily fluctuate. Another youth worker identified a particularly important barrier to collaboration: because of workers’ relatively low remuneration and high levels of work stress, the turnover rates are high. The consequence of this is as follows: The other barrier from my point is that you’re talking to somebody about a student “at-risk”, and within 14 months or 18 months a new person comes in [to that position] then you’ve got to start again. This way you miss a lot of information [which could be beneficial for the youth]. Conclusion The Privacy Act creates a dilemma in that it can be either beneficial or counter-productive for a student’s security. To be blunt, a youth who has suicided might have had their privacy protected, but not their life. Lack of funding can also be a constraint on collaboration by undermining stability and autonomy in the workforce, and blocking inter-agency initiatives. Lack of awareness about cultural differences can also affect unity of action. The deepening inequality between the “haves” and “have-nots” in the Australian society, and the Howard government’s harshness on national security issues, can also pose barriers to collaboration on youth issues. Despite these exigencies and dilemmas, it would seem that collaboration is “the only game” when it comes to helping students “at-risk”. To enhance this collaboration, there needs to be a sensible modification of legal restrictions to information sharing, an increase in government funding and support for inter-agency cooperation and informal information sharing, and an increased awareness about the cultural needs of minority groups and knowledge of the mainstream underclass. Acknowledgments The research is part of a major Australian Research Council (ARC) funded project, Smart Communities. The authors very gratefully acknowledge the contribution of the interviewees, and thank *Donald E. Scott for conducting the interviews. References Australian Bureau of Statistics. 1996 and 2001. Balnaves, Mark, and Joe Luca. “The Impact of Digital Persona on the Future of Learning: A Case Study on Digital Repositories and the Sharing of Information about Children At-Risk in Western Australia”, paper presented at Ascilite, Brisbane (2005): 49-56. 10 April 2006. http://www.ascilite.org.au/conferences/brisbane05/blogs/proceedings/ 06_Balnaves.pdf>. Dreher, Tanya. ‘Targeted’: Experiences of Racism in NSW after September 11, 2001. Sydney: University of Technology, 2005. Elliot-Farrelly, Terri. “Australian Aboriginal Suicide: The Need for an Aboriginal Suicidology”? Australian e-Journal for the Advancement of Mental Health, 3.3 (2004): 1-8. 15 April 2006 http://www.auseinet.com/journal/vol3iss3/elliottfarrelly.pdf>. Farmer, James. A. High-Risk Teenagers: Real Cases and Interception Strategies with Resistant Adolescents. Springfield, Ill.: C.C. Thomas, 1990. Ferguson, Harry. Protecting Children in Time: Child Abuse, Child Protection and the Consequences of Modernity. London: Palgrave Macmillan, 2004. Foucault, Michel. Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Ed. Colin Gordon, trans. Colin Gordon et al. New York: Pantheon, 1980. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. Rouf, Khadji. “Myself in Echoes. My Voice in Song.” Ed. A. Bannister, et al. Listening to Children. London: Longman, 1990. Scott E. Donald. “Exploring Communication Patterns within and across a School and Associated Agencies to Increase the Effectiveness of Service to At-Risk Individuals.” MS Thesis, Curtin University of Technology, August 2005. The Age. “Investing in People Means Investing in the Future.” The Age 5 March, 2005. 15 April 2006 http://www.theage.com.au>. Watson, Malcolm, et al. “Pathways to Aggression in Children and Adolescents.” Harvard Educational Review, 74.4 (Winter 2004): 404-428. Citation reference for this article MLA Style Kabir, Nahid, and Mark Balnaves. "Students “at Risk”: Dilemmas of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>. APA Style Kabir, N., and M. Balnaves. (May 2006) "Students “at Risk”: Dilemmas of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>.

At one point in Victor Hugo’s novel, The Hunchback of Notre Dame, the archdeacon, Claude Frollo, looked up from a book on his table to the edifice of the gothic cathedral, visible from his canon’s cell in the cloister of Notre Dame: “Alas!” he said, “this will kill that” (146). Frollo’s lament, that the book would destroy the edifice, captures the medieval cleric’s anxiety about the way in which Gutenberg’s print technology would become the new universal means for recording and communicating humanity’s ideas and artistic expression, replacing the grand monuments of architecture, human engineering, and craftsmanship. For Hugo, architecture was “the great handwriting of humankind” (149). The cathedral as the material outcome of human technology was being replaced by the first great machine—the printing press. At this point in the third millennium, some people undoubtedly have similar anxieties to Frollo: is it now the book’s turn to be destroyed by yet another great machine? The inclusion of “post print” in our title is not intended to sound the death knell of the book. Rather, we contend that despite the enduring value of print, digital publishing is “present and active” and is changing the way in which research, particularly in the humanities, is being undertaken. Our approach has three related parts. First, we consider how digital technologies are changing the way in which content is constructed, customised, modified, disseminated, and accessed within a global, distributed network. This section argues that the transition from print to electronic or digital publishing means both losses and gains, particularly with respect to shifts in our approaches to textuality, information, and innovative publishing. Second, we discuss the Children’s Literature Digital Resources (CLDR) project, with which we are involved. This case study of a digitising initiative opens out the transformative possibilities and challenges of digital publishing and e-scholarship for research communities. Third, we reflect on technology’s capacity to bring about major changes in the light of the theoretical and practical issues that have arisen from our discussion. I. Digitising in a “post-print age” We are living in an era that is commonly referred to as “the late age of print” (see Kho) or the “post-print age” (see Gunkel). According to Aarseth, we have reached a point whereby nearly all of our public and personal media have become more or less digital (37). As Kho notes, web newspapers are not only becoming increasingly more popular, but they are also making rather than losing money, and paper-based newspapers are finding it difficult to recruit new readers from the younger generations (37). Not only can such online-only publications update format, content, and structure more economically than print-based publications, but their wide distribution network, speed, and flexibility attract advertising revenue. Hype and hyperbole aside, publishers are not so much discarding their legacy of print, but recognising the folly of not embracing innovative technologies that can add value by presenting information in ways that satisfy users’ needs for content to-go or for edutainment. As Kho notes: “no longer able to satisfy customer demand by producing print-only products, or even by enabling online access to semi-static content, established publishers are embracing new models for publishing, web-style” (42). Advocates of online publishing contend that the major benefits of online publishing over print technology are that it is faster, more economical, and more interactive. However, as Hovav and Gray caution, “e-publishing also involves risks, hidden costs, and trade-offs” (79). The specific focus for these authors is e-journal publishing and they contend that while cost reduction is in editing, production and distribution, if the journal is not open access, then costs relating to storage and bandwith will be transferred to the user. If we put economics aside for the moment, the transition from print to electronic text (e-text), especially with electronic literary works, brings additional considerations, particularly in their ability to make available different reading strategies to print, such as “animation, rollovers, screen design, navigation strategies, and so on” (Hayles 38). Transition from print to e-text In his book, Writing Space, David Bolter follows Victor Hugo’s lead, but does not ask if print technology will be destroyed. Rather, he argues that “the idea and ideal of the book will change: print will no longer define the organization and presentation of knowledge, as it has for the past five centuries” (2). As Hayles noted above, one significant indicator of this change, which is a consequence of the shift from analogue to digital, is the addition of graphical, audio, visual, sonic, and kinetic elements to the written word. A significant consequence of this transition is the reinvention of the book in a networked environment. Unlike the printed book, the networked book is not bound by space and time. Rather, it is an evolving entity within an ecology of readers, authors, and texts. The Web 2.0 platform has enabled more experimentation with blending of digital technology and traditional writing, particularly in the use of blogs, which have spawned blogwriting and the wikinovel. Siva Vaidhyanathan’s The Googlization of Everything: How One Company is Disrupting Culture, Commerce and Community … and Why We Should Worry is a wikinovel or blog book that was produced over a series of weeks with contributions from other bloggers (see: http://www.sivacracy.net/). Penguin Books, in collaboration with a media company, “Six Stories to Start,” have developed six stories—“We Tell Stories,” which involve different forms of interactivity from users through blog entries, Twitter text messages, an interactive google map, and other features. For example, the story titled “Fairy Tales” allows users to customise the story using their own choice of names for characters and descriptions of character traits. Each story is loosely based on a classic story and links take users to synopses of these original stories and their authors and to online purchase of the texts through the Penguin Books sales website. These examples of digital stories are a small part of the digital environment, which exploits computer and online technologies’ capacity to be interactive and immersive. As Janet Murray notes, the interactive qualities of digital environments are characterised by their procedural and participatory abilities, while their immersive qualities are characterised by their spatial and encyclopedic dimensions (71–89). These immersive and interactive qualities highlight different ways of reading texts, which entail different embodied and cognitive functions from those that reading print texts requires. As Hayles argues: the advent of electronic textuality presents us with an unparalleled opportunity to reformulate fundamental ideas about texts and, in the process, to see print as well as electronic texts with fresh eyes (89–90). The transition to e-text also highlights how digitality is changing all aspects of everyday life both inside and outside the academy. Online teaching and e-research Another aspect of the commercial arm of publishing that is impacting on academe and other organisations is the digitising and indexing of print content for niche distribution. Kho offers the example of the Mark Logic Corporation, which uses its XML content platform to repurpose content, create new content, and distribute this content through multiple portals. As the promotional website video for Mark Logic explains, academics can use this service to customise their own textbooks for students by including only articles and book chapters that are relevant to their subject. These are then organised, bound, and distributed by Mark Logic for sale to students at a cost that is generally cheaper than most textbooks. A further example of how print and digital materials can form an integrated, customised source for teachers and students is eFictions (Trimmer, Jennings, & Patterson). eFictions was one of the first print and online short story anthologies that teachers of literature could customise to their own needs. Produced as both a print text collection and a website, eFictions offers popular short stories in English by well-known traditional and contemporary writers from the US, Australia, New Zealand, UK, and Europe, with summaries, notes on literary features, author biographies, and, in one instance, a YouTube movie of the story. In using the eFictions website, teachers can build a customised anthology of traditional and innovative stories to suit their teaching preferences. These examples provide useful indicators of how content is constructed, customised, modified, disseminated, and accessed within a distributed network. However, the question remains as to how to measure their impact and outcomes within teaching and learning communities. As Harley suggests in her study on the use and users of digital resources in the humanities and social sciences, several factors warrant attention, such as personal teaching style, philosophy, and specific disciplinary requirements. However, in terms of understanding the benefits of digital resources for teaching and learning, Harley notes that few providers in her sample had developed any plans to evaluate use and users in a systematic way. In addition to the problems raised in Harley’s study, another relates to how researchers can be supported to take full advantage of digital technologies for e-research. The transformation brought about by information and communication technologies extends and broadens the impact of research, by making its outputs more discoverable and usable by other researchers, and its benefits more available to industry, governments, and the wider community. Traditional repositories of knowledge and information, such as libraries, are juggling the space demands of books and computer hardware alongside increasing reader demand for anywhere, anytime, anyplace access to information. Researchers’ expectations about online access to journals, eprints, bibliographic data, and the views of others through wikis, blogs, and associated social and information networking sites such as YouTube compete with the traditional expectations of the institutions that fund libraries for paper-based archives and book repositories. While university libraries are finding it increasingly difficult to purchase all hardcover books relevant to numerous and varied disciplines, a significant proportion of their budgets goes towards digital repositories (e.g., STORS), indexes, and other resources, such as full-text electronic specialised and multidisciplinary journal databases (e.g., Project Muse and Proquest); electronic serials; e-books; and specialised information sources through fast (online) document delivery services. An area that is becoming increasingly significant for those working in the humanities is the digitising of historical and cultural texts. II. Bringing back the dead: The CLDR project The CLDR project is led by researchers and librarians at the Queensland University of Technology, in collaboration with Deakin University, University of Sydney, and members of the AustLit team at The University of Queensland. The CLDR project is a “Research Community” of the electronic bibliographic database AustLit: The Australian Literature Resource, which is working towards the goal of providing a complete bibliographic record of the nation’s literature. AustLit offers users with a single entry point to enhanced scholarly resources on Australian writers, their works, and other aspects of Australian literary culture and activities. AustLit and its Research Communities are supported by grants from the Australian Research Council and financial and in-kind contributions from a consortium of Australian universities, and by other external funding sources such as the National Collaborative Research Infrastructure Strategy. Like other more extensive digitisation projects, such as Project Gutenberg and the Rosetta Project, the CLDR project aims to provide a centralised access point for digital surrogates of early published works of Australian children’s literature, with access pathways to existing resources. The first stage of the CLDR project is to provide access to digitised, full-text, out-of-copyright Australian children’s literature from European settlement to 1945, with selected digitised critical works relevant to the field. Texts comprise a range of genres, including poetry, drama, and narrative for young readers and picture books, songs, and rhymes for infants. Currently, a selection of 75 e-texts and digital scans of original texts from Project Gutenberg and Internet Archive have been linked to the Children’s Literature Research Community. By the end of 2009, the CLDR will have digitised approximately 1000 literary texts and a significant number of critical works. Stage II and subsequent development will involve digitisation of selected texts from 1945 onwards. A precursor to the CLDR project has been undertaken by Deakin University in collaboration with the State Library of Victoria, whereby a digital bibliographic index comprising Victorian School Readers has been completed with plans for full-text digital surrogates of a selection of these texts. These texts provide valuable insights into citizenship, identity, and values formation from the 1930s onwards. At the time of writing, the CLDR is at an early stage of development. An extensive survey of out-of-copyright texts has been completed and the digitisation of these resources is about to commence. The project plans to make rich content searchable, allowing scholars from children’s literature studies and education to benefit from the many advantages of online scholarship. What digital publishing and associated digital archives, electronic texts, hypermedia, and so forth foreground is the fact that writers, readers, publishers, programmers, designers, critics, booksellers, teachers, and copyright laws operate within a context that is highly mediated by technology. In his article on large-scale digitisation projects carried out by Cornell and University of Michigan with the Making of America collection of 19th-century American serials and monographs, Hirtle notes that when special collections’ materials are available via the Web, with appropriate metadata and software, then they can “increase use of the material, contribute to new forms of research, and attract new users to the material” (44). Furthermore, Hirtle contends that despite the poor ergonomics associated with most electronic displays and e-book readers, “people will, when given the opportunity, consult an electronic text over the print original” (46). If this preference is universally accurate, especially for researchers and students, then it follows that not only will the preference for electronic surrogates of original material increase, but preference for other kinds of electronic texts will also increase. It is with this preference for electronic resources in mind that we approached the field of children’s literature in Australia and asked questions about how future generations of researchers would prefer to work. If electronic texts become the reference of choice for primary as well as secondary sources, then it seems sensible to assume that researchers would prefer to sit at the end of the keyboard than to travel considerable distances at considerable cost to access paper-based print texts in distant libraries and archives. We considered the best means for providing access to digitised primary and secondary, full text material, and digital pathways to existing online resources, particularly an extensive indexing and bibliographic database. Prior to the commencement of the CLDR project, AustLit had already indexed an extensive number of children’s literature. Challenges and dilemmas The CLDR project, even in its early stages of development, has encountered a number of challenges and dilemmas that centre on access, copyright, economic capital, and practical aspects of digitisation, and sustainability. These issues have relevance for digital publishing and e-research. A decision is yet to be made as to whether the digital texts in CLDR will be available on open or closed/tolled access. The preference is for open access. As Hayles argues, copyright is more than a legal basis for intellectual property, as it also entails ideas about authorship, creativity, and the work as an “immaterial mental construct” that goes “beyond the paper, binding, or ink” (144). Seeking copyright permission is therefore only part of the issue. Determining how the item will be accessed is a further matter, particularly as future technologies may impact upon how a digital item is used. In the case of e-journals, the issue of copyright payment structures are evolving towards a collective licensing system, pay-per-view, and other combinations of print and electronic subscription (see Hovav and Gray). For research purposes, digitisation of items for CLDR is not simply a scan and deliver process. Rather it is one that needs to ensure that the best quality is provided and that the item is both accessible and usable by researchers, and sustainable for future researchers. Sustainability is an important consideration and provides a challenge for institutions that host projects such as CLDR. Therefore, items need to be scanned to a high quality and this requires an expensive scanner and personnel costs. Files need to be in a variety of formats for preservation purposes and so that they may be manipulated to be useable in different technologies (for example, Archival Tiff, Tiff, Jpeg, PDF, HTML). Hovav and Gray warn that when technology becomes obsolete, then content becomes unreadable unless backward integration is maintained. The CLDR items will be annotatable given AustLit’s NeAt funded project: Aus-e-Lit. The Aus-e-Lit project will extend and enhance the existing AustLit web portal with data integration and search services, empirical reporting services, collaborative annotation services, and compound object authoring, editing, and publishing services. For users to be able to get the most out of a digital item, it needs to be searchable, either through double keying or OCR (optimal character recognition). The value of CLDR’s contribution The value of the CLDR project lies in its goal to provide a comprehensive, searchable body of texts (fictional and critical) to researchers across the humanities and social sciences. Other projects seem to be intent on putting up as many items as possible to be considered as a first resort for online texts. CLDR is more specific and is not interested in simply generating a presence on the Web. Rather, it is research driven both in its design and implementation, and in its focussed outcomes of assisting academics and students primarily in their e-research endeavours. To this end, we have concentrated on the following: an extensive survey of appropriate texts; best models for file location, distribution, and use; and high standards of digitising protocols. These issues that relate to data storage, digitisation, collections, management, and end-users of data are aligned with the “Development of an Australian Research Data Strategy” outlined in An Australian e-Research Strategy and Implementation Framework (2006). CLDR is not designed to simply replicate resources, as it has a distinct focus, audience, and research potential. In addition, it looks at resources that may be forgotten or are no longer available in reproduction by current publishing companies. Thus, the aim of CLDR is to preserve both the time and a period of Australian history and literary culture. It will also provide users with an accessible repository of rare and early texts written for children. III. Future directions It is now commonplace to recognize that the Web’s role as information provider has changed over the past decade. New forms of “collective intelligence” or “distributed cognition” (Oblinger and Lombardi) are emerging within and outside formal research communities. Technology’s capacity to initiate major cultural, social, educational, economic, political and commercial shifts has conditioned us to expect the “next big thing.” We have learnt to adapt swiftly to the many challenges that online technologies have presented, and we have reaped the benefits. As the examples in this discussion have highlighted, the changes in online publishing and digitisation have provided many material, network, pedagogical, and research possibilities: we teach online units providing students with access to e-journals, e-books, and customized archives of digitised materials; we communicate via various online technologies; we attend virtual conferences; and we participate in e-research through a global, digital network. In other words, technology is deeply engrained in our everyday lives. In returning to Frollo’s concern that the book would destroy architecture, Umberto Eco offers a placatory note: “in the history of culture it has never happened that something has simply killed something else. Something has profoundly changed something else” (n. pag.). Eco’s point has relevance to our discussion of digital publishing. The transition from print to digital necessitates a profound change that impacts on the ways we read, write, and research. As we have illustrated with our case study of the CLDR project, the move to creating digitised texts of print literature needs to be considered within a dynamic network of multiple causalities, emergent technological processes, and complex negotiations through which digital texts are created, stored, disseminated, and used. Technological changes in just the past five years have, in many ways, created an expectation in the minds of people that the future is no longer some distant time from the present. 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