Academic literature on the topic 'New York (State). Office of Drug Abuse Services'

Cannabis is one of the most commonly elicited substances abused. It is easily accessible, inexpensive, and the ultimate gateway drug. Synthetic cannabinoid has been known to be packaged under numerous trade names such as “K2, spice, AK-47, Geeked up, Smacked, and Green Giant..etc”. K2 Abuse has been rising more recently in New York State, especially among lower socioeconomic areas and among younger male individuals. Clinicians should be educated and awareness should be increased regarding patient presentation, treatment, as well as management. Although, treatment is ultimately supportive therapy, long term management to prevent future abuse is of prime importance. Death is rare but there can be serious risks associated with K2 abuse.Case presentationPatient is a 36-year-old male with unknown PMH who presented with bizarre behavior and anxiety. Patient was uncooperative and portraying repetitive tangential thoughts. He was found agitated, screaming “I am king of the world, and I feel good”. The patient admits to waking up this morning and smoking marijuana and his last memory since then was being in the ambulance. The patient denies any psychiatric medical history but is unable to provide any further details. The patient's family reports unusual behavior in the past few days such as religious connotations, nonsensical rantings, and repetitive thoughts causing them to contact emergency medical services. The family also admits to depressive episodes as well as suicidal ideations found in his personal written lyrics. He admits to drinking 1 pint of various types of liquor well as 6+ beers per day for >15 years. He denies any history of smoking, although he does smoke marijuana daily as per family.On physical exam his vital signs were normal. Patient was tearful and exhibiting repetitive thoughts, despite having a somnolent general affect. The rest of the physical exam was within normal limits. Patient received intravenous crystalloid fluids, Haldol 5 mg IV, and Benzodiazepine IV. Pertinent laboratory findings is significant for elevated lactate 3.4, hypokalemia 2.2, and an elevated ammonia 53. Other laboratory findings were within normal limits. CXR and Head CT showed no significant findings and EKG was within normal limits.Hospital course complicated with aspiration pneumonia. Patient received a full course of antibiotic therapy. Blood and urine culture showed no growth through admission. Social worker and case manager were involved and patient was offered referral to chemical dependency programs which he refused. Patient was discharged in stable condition and asked to follow up with primary care physician.DiscussionThe recreational use of synthetic cannabinoids such as K2 has been on the rise especially in younger male individuals and in lower socioeconomic status neighborhoods. In turn, the number of admissions secondary to acute intoxication has been increasing in hospitals all over the nation. More recently, since the advent of synthetic cannabinoids, there has been two reported confirmed deaths in New York City associated with K2 abuse. This can be attributed the drugs widespread accessibility. Synthetic marijuana has been legally available in the internet, local smoke shops, and even convenience stores. K2 has been advertised as the new, legal, and more cost effective way to get “high”. The popularity of this new class of drug “fad” is increasing in popularity as an alternative to marijuana and will continue to be a growing health concern.The use of K2 and other synthetic forms of recreational substances has become an escalating problem in many institutions nationwide. Increasing awareness will allow for improved preparedness as well as provide further data on this situation. .

Adolescent experimentation with alcohol, tobacco, or other drugs is commonplace, and limited access to screening and treatment services poses a significant public health risk. This study identified alcohol, tobacco, and other drug services available for adolescents at community health center sites in New York. A survey was distributed to medical and behavioral health directors across 54 community health center organizations serving 255 primary care adolescent sites. One third of sites required adolescent screening for substance use disorders (SUDs). Twenty-eight percent of sites said all/nearly all (80%-100%) and 12% said most (60%-79%) adolescents actually were screened. On-site tobacco cessation treatment and substance abuse counseling were offered at 53% and 14% of sites, respectively. Multilevel models suggested that community health center organizations positively influenced sites’ adolescent SUD screening and tobacco treatment. Additional investment in adolescent behavioral health screening and treatment is needed to reduce alcohol, illicit drug, or tobacco use among the underserved.

To assess the system's comprehensiveness in provision of public managed mental health care South Beach Psychiatric Center surveyed a sample ( n = 54) of its primary therapists employed in its outpatient departments which have recently been reconligured as key components of the New York State Office of Mental Health Prepaid Mental Health Plan. They are intended to be comprehensive resource and treatment centers which optimize recovery in a deregulated, capitated environment. As key informants, the primary therapists were asked to rate the difficulty they experience in providing or arranging adequate services and support groups in 19 areas. They were also asked to indicate if the fundamental problem was one of access, information, quality, or supply. The five areas with the highest ratings of difficulty were housing or residential services, substance-abuse services, dental care, general health care, and employment or vocational services. The reason for difficulty most endorsed for these areas was supply. It is suggested that capitated managed care contracts can create incentives to increase the supply of such services.

Background: Few studies have attempted to assess the effectiveness of formulary management in reducing the antipsychotic costs and utilization across U.S. state Medicaid programs, despite concerns about the potential impact of such formulary management on Medicaid patient health outcomes. Objectives: Compare antipsychotic utilization and total costs across Medicaid states with preferred drug list (PDL) programs vs. states without PDLs in place. Methods: The following data from 48 Medicaid fee-for-service (FFS) programs were collected for calendar year 2010: antipsychotic prescription use (IMS Health); formulary management (MediMedia, Medicaid FFS programs’ websites), and patient enrollment (MediMedia). For each program, the total antipsychotic cost per capita was estimated by multiplying antipsychotic utilization by list price (First DataBank), then dividing by program enrollment. To control for differences in the prevalence of antipsychotic use among Medicaid patients across states, cost estimates were adjusted using state-level mental-health illness prevalence data (Kaiser Family Foundation, Substance Abuse and Mental Health Services Administration [SAMHSA], and Thomson Healthcare). Volume-based market share of branded antipsychotics was also calculated to compare branded vs. generic antipsychotic use across states. Significance of difference between the means of PDL and non-PDL states was tested using a two-sided, two sample t-test, assuming unequal variances between samples. Results: Among the 48 states studied, 33 (68.8%) used PDLs as a means to limit access to branded antipsychotic medications, including those states with the largest populations with a mental-health illness (e.g. New York, California, Texas). In our analyses, the average difference in antipsychotic costs per capita between PDL and non-PDL states was less than $0.6M or 1.5% (p=0.95). The average difference in antipsychotic utilization per capita was less than 2.8% (p=0.91) and in branded antipsychotic market share was 0.7% (p=0.59). Conclusions: Although a majority of Medicaid states use PDLs to manage antipsychotic utilization, this analysis found no evidence of significant advantages for these Medicaid programs in terms of lowering percapita antipsychotic costs or increasing generic utilization.

IntroductionPeople say, “don’t you ever want to come off?” I don’t know. The thought of me getting up without taking something is totally... to me that’s normal. If I haven’t taken anything then I’m not normal. And for me to even, I can’t contemplate not taking something, you know. I’m not a lost cause. I know what my problem is. It’s other people that want me to stop. I don’t want to stop. I don’t want to. Does that make sense to you? (Mya)This extract is taken from an interview that formed part of my doctoral research looking at people’s experiences of injecting drug use and treatment services in London, UK. Here I consider one of the ways participants described their use of drugs through a concept of becoming “normal.” I pay particular attention to Mya’s account and explore the very sense-making that her question (above) demands. Mya uses the concept of normality not only to reflect how drugs have become part of her everyday routines, or part of feeling normal, but actually in materially becoming herself—in embodying a “normal body.” As she puts it, “if I haven’t taken anything then I am not normal.” In this sense, Mya’s problem is not the drugs, but the people who want her to stop taking them. This understanding is important for challenging recent policy shifts towards reducing opiate replacement/substitution services in the UK (HM Government; Home Office).Methods The study took place from January to September 2014, and included participant observation at a drug treatment service, interviews with service providers, and “creative” interviews with people who inject drugs. The project was granted ethical approval by the London School of Hygiene and Tropical Medicine Ethics Committee and the NHS Regional Ethics Committee. All participants were given pseudonyms.The creative interview is a term coined by Jennifer Mason to describe an in-depth semi-structured interview which produces additional types of data beyond the spoken word. The method was employed to explore participants’ feelings of embodiment as enacted in the drug-using “event.” I used a body mapping (drawing) task in these interviews to aid the communication of hard-to-articulate visceral experiences and depict the many actors, human and nonhuman, involved. (For a fuller explanation of the “events” perspective and methods taken in this study, please see Dennis 2016.) Below, I draw both from Mya’s narrative and her pictorial account.Becoming “Normal” with DiamorphineMya is a 52-year-old woman who was recruited to the study through word of mouth. She attended a supervised injecting clinic where another participant informed her about the study. The purpose of this clinic is to prescribe injectable diamorphine (pharmaceutical heroin) for clients to administer under supervised conditions. This unique service is specifically targeted at people who have previously struggled with the more orthodox opiate substitution treatments, such as methadone and buprenorphine. Mya explained that she had a long history of using street heroin, but in the last ten years has been injecting legally and has also illegally sought diamorphine. Mya’s drug use had become very hard to sustain financially, both in paying for private prescriptions and in the illegal drugs market, and therefore she wanted a prescription through the National Health Service. She was told that this was only possible through this clinic. However, the clinic’s intention was always to reduce this consumption, which Mya did not want to accept. This is because, as she explained, without drugs she is “not normal.”A rhetoric of “normality,” as deployed in the drug field, has taken two dominant paths. The first is in Parker et al.’s “normalisation thesis,” which documents a move during the 1990s when drug use, albeit “recreational drug use,” became increasingly common. A concept of “normalisation” is used to explain this social shift in acceptability towards drug taking. The second lies in a Foucauldian-influenced embodied idea of performing normality in line with dominant neoliberal discourses. For example, Nettleton et al.’s study with recovering heroin users employs a concept of “normalisation” to explore the ways in which people talk about regaining certain bodily practices to fit in with “the norm.” Using the work of Michel Foucault, and his concept of governmentality more specifically, Nettleton et al. argue that “normalisation” is “a crucial aspect of neo-liberal societies, where individuals are encouraged through [decentralised] political projects to become normal: ‘the judges of normality are everywhere’ (Foucault, 1977)” (175). Although there are vast differences, both these accounts seem to share an understanding of normality as a socially or discursively produced set of practices.However, Mya’s narrative of becoming normal seems to be doing something different. She highlights how she becomes normal with drugs in a way that suggests that without drugs she is not normal. This highlights the material work involved in achieving this “normal” state. It is clear that being normal is something we do (both theories above consider normal behaviour as performative) rather than it being pre-defined. But for Mya this is enacted in an ontological rather than learnt way as she connects with drugs. To know normality—“to me that’s normal”—and to be normal—“if I haven’t taken anything then I’m not normal”—are conflated. Karen Barad, in her theory of agential realism, would call this an intra-action rather than an inter-action, where what we know (epistemology) and what is (ontology) collide, or rather elide. It is in these entanglements of matter and meaning that Mya becomes normal. Mya’s narrative highlights the human body as an assemblage (Deleuze and Guattari) in which drugs have become a part. In this sense, drugs can be seen as part of this embodied self rather than separate. Consequently, Mya’s account is about more than how her body interacts with drugs, but rather how they become together. Drawing from Deleuze’s ontology of becoming, this is the idea that life does not start with any given entities or organisms, but that these forms are brought into being through the forces of life, and as such they are in a constant state of flux, becoming something else.This can challenge ideas of “recovery” (e.g. Home Office) where people are expected to remove themselves from drugs in order to regain their “normal” self. If one’s “normal” includes drugs this calls into question the very attempt to de-couple an entangled relationship that, as another participant put it, “has been a long time in the making” (my emphasis). Therefore, it is perhaps not surprising that Mya explains with a heavy heart that she is feeling substantial pressure to reduce her prescription. She feels the clinic staff fail to understand how drugs are part of her and what constitutes her “normal.” Thus, as she sees it, her “problem” is not the drugs themselves, but the people who want her to stop taking them. Mya’s frustrations start to make more sense—to return to the question in the epigraph—when we think about the body as something we do, involved in a constant task of keeping oneself together.Keeping Oneself TogetherOne does not hang together as a matter of course: keeping oneself together is something the embodied person needs to do. The person who fails to do so dies. (Mol and Law 43)Mol and Law argue that bodies are not something we have but something we do, and that bodies are actively held together through a series of practices. For instance, in their example of hypoglycaemia, a pin prick of blood needs to be taken for the condition to be known, and then counteracted by eating a sugary substance (49). Thinking about Mya’s account of becoming normal in these terms, drugs, instead of being seen as “evil” objects of misuse, can, for Mya at least, be part of this vital (life) project of keeping oneself together. This thoroughly blurs the distinctions between “good” medicine (life sustaining/enhancing) and “bad” drugs of abuse (life destroying). Following a Deleuzian understanding of the human body as an assemblage, making the body “actualise” as one is a process of life: “‘A’ or ‘a’ (one) is always the index of a multiplicity: an event, a singularity, a life...” (Deleuze 388). As such, making bodily boundaries becomes essential. For Mya, drugs are part of this individualisation process in quite overt ways. For example, in her body map (Figure 1) she drew a picture of herself inside a cloud, with voices shouting inwards, penetrating the barrier from outside. About these she said, they are “shouting at me,” “telling me what to do,” and “what’s best for me.” But she was at pains to point out that the depicted cloud is not about representing a pleasurable or disassociated feeling, but more to do with blocking out these intruding voices telling her how to live her life so that they “can’t get to me”:Mya: That makes it sound like the drug makes me feel like I’m in a cloud, it doesn’t, cos I just feel normal, it just helps me to, to deal with things better, it helps me to get less stressful, does that make sense?Author: Normal?Mya: YeahAuthor: So if you haven’t had it, you feel more on edge?Mya: I’m a complete nervous wreck. I’ll be jumping everywhere, you know, if someone opens the window of a bus and I’m jumping.Figure 1: Mya’s Body MapFor Mya, then, her drug use is not about pleasure, or pain for that matter, but about something altogether more vital: it is about keeping together in a stressful, invasive world, to “deal with things better.” It seems that Mya’s drawing—through which she was asked to depict her feelings when using drugs—is about trying to hold the permeable, leaky body together. For the injecting body, which regularly incorporates and excorporates drugs, is an active/metabolic body:The active body has semi-permeable boundaries [...] inside and outside are not so stable. Metabolism, after all, is about eating, drinking and breathing; about defecating, urinating and sweating. For a metabolic body incorporation and excorporation are essential. (Mol and Law 54)A similar argument is made by Vitellone, citing Keane:Heroin is not separate from but becomes central to the body, selfhood, and processes of individualization. Thus according to Keane “a drug is something external that becomes internalized, blurring the distinction between not only inside/outside but also self/other”. (166; see also Keane)In Mya’s drawing and account, drugs are intimately involved in the task of individuating—in making clear boundaries between her and the world. In this sense, her drawing of a cloud can be seen almost like an extra layer of skin.This also occurs in the accounts of two other participants. One female participant commented on how, without drugs, she does not feel herself, to the point that she said, “I don’t want to be in my own skin.” And a male participant also used similar language to note that without heroin (even though he is prescribed methadone, an opiate substitute) he can feel “disembodied”:Everything is all “oh oh” [he makes sounds and body movements to show a fear of things getting too close] like that, everything is like right, like if you’re trying to walk around the streets and it’s just like you can’t handle busy high streets and you know busy like tubes and ...In these accounts, drugs are playing a key role in this boundary work, that is, in enacting the body as One. This resonates strongly with Donna Haraway’s idea of individualisation as “a strategic defense problem” (212). This is the idea that the individual body is not something we are born with, but something we strive towards. Haraway argues that “bodies have become cyborgs,” where “the cyborg is text, machine, body, and metaphor” (212). Mya takes great care in making sure that I have understood this process of boundary-making, which is essential to the cyborg, and on several occasions checks back with me to confirm that she is making sense. She gives the impression that she has been explaining these feelings for years, but still does not feel fully understood. This is perhaps why she seems so thrilled when she feels I have finally got a handle on the dynamic:Mya: But the methadone makes me feel heavy, lethargic, with the diamorphine I can get on with being normal, more better, and not so sleepy, does that make sense? [...] It just helps me cope with everything. You know what I mean, everything. Even ...Author: Like taking the edge off things?Mya: That’s it, the edge off things, you’ve got it! I’ve never thought of that before, that’s a good way of putting it.Author: No cos I was thinking about what you were saying about how you can feel anxious and stuff, and I can imagine it just ...Mya: You’re right, you’ve done it in a nut shell there. Cos people have asked me that before and I haven’t been able to answer. That is a good answer. It takes the edge of things. Yeah.At the end of the interview, and long past this initial reference, Mya shows appreciation of this phrase once more, as an expression which she feels could help in her bid to be better understood:Author: Anyway, I’ll end the interview there.Mya: Was that alright?Author: Yeah, perfect. Is there anything else that you think is important that I’ve missed out?Mya: No not at all. I think you’ve just helped me there by saying it takes the edge off things, I’ve been trying to put that into words for a long time, I didn’t know how to say it ...Although these experiences are of course linked to withdrawal symptoms as a particular arrangement of bodily connections, when I ask about this, it is evident that it is also about something more. For example, in trying to get at why Mya feels she needs diamorphine rather than methadone, she talks about it being “cleaner,” “purer,” “less groggy.” And even though I prompt her on the potential enjoyment, she links “the buzz” to being able to get on with “normal things,” saying “I can act more normal with the heroin”:Mya: Definitely it’s less groggy.Author: And does it give you a slight buzz also?Mya: Sometimes it does yeah. Like I can get on with my housework better and things like that, day to day things, I can act more normal with the heroin. With just the methadone, things just slip.With an interesting use of the term, Mya says that with methadone (which would be the more usual opiate prescribed in heroin treatment) “things just slip.” Again, there is a sense of diamorphine holding her together, in a way that without it she would “slip.” This perhaps highlights the slipperiness of connections that are only ever “partial” (Haraway 181). Rather than becoming too porous, with methadone she becomes too shut off or “groggy,” and again her body becomes unable to do things. This is perhaps why she is so insistent that diamorphine stays put in her life: “I’m not going to lie, even if I don’t get it, I’m still going to use the diamorphine.” Or, in Haraway’s words, she “would rather be a cyborg than a goddess”(181) —she would rather endure the political and potentially criminal consequences of requiring this “outside” substance than pretend to live apart from/above the material world.ConclusionWhen we consider bodies as something we do, rather than have, we see that rather than Mya’s account of normality reflecting a social change (Parker et al.) or solely discursive embodiment (Nettleton et al.), it actually refers to how she becomes her “normal self” in more material ways. Mya’s account thoroughly disrupts a separation of object/subject, as well as several other binaries that underpin contemporary ideas of psychoactive drug use and the body, including drug/medicine, inner/outer, self/other, and of course, normal/pathological. Instead, and in trying to do justice to Mya’s question which opened the essay, her body is seen connecting with drugs in a way that holds her together (as One) in becoming “normal.” Consequently, her fears over having these drugs stopped are very real concerns over a disruption to her corporeality, which demand to be taken seriously. This calls for urgent questions to be asked over current UK policy trends toward eliminating diamorphine prescribing services (see O’Mara) and reducing opiate substitution more generally.References Barad, Karen. Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Durham: Duke UP, 2007.Deleuze, Gilles. “Immanence: A Life.” Two Regimes of Madness: Texts and Interviews 1975–1995. Ed. David Lapoujade. New York: Semiotext(e), 2006. 384­–91.Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. London: Continuum, 2004.Dennis, Fay. “Encountering ‘Triggers:’ Drug-Body-World Entanglements of Injecting Drug Use.” Contemporary Drug Problems (2016). <http://cdx.sagepub.com/content/early/2016/03/14/0091450916636379.full.pdf?ijkey=6yYSsmgMiHATwe6&keytype=finite>.Haraway, Donna. Simians, Cyborgs, and Women: The Reinvention of Nature. London: Free Association Books, 1991. HM Government. “Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life.” Home Office, 2010. 1 Jan. 2011 <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98026/drug-strategy-2010.pdf>.Home Office. “Putting Full Recovery First.” Home Office, 2012. 5 Feb. 2013 <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98010/recovery-roadmap.pdf>.Keane, Helen. What’s Wrong with Addiction? Melbourne: Melbourne UP, 2002.Mason, Jennifer. “What Is Creative Interviewing?” 2010. 10 May 2013 <http://www.method s.manchester.ac.uk/methods/creativeinterviewing/>.Mol, Annemarie, and John Law. “Embodied Action, Enacted Bodies. The Example of Hypoglycaemia.” Body & Society 10.2 (2004): 43-62.Nettleton, Sarah, Joanne Neale, and Lucy Pickering. “‘I Just Want to Be Normal’: An Analysis of Discourses of Normality among Recovering Heroin Users.” Health 17.2 (2013): 174–190.O’Mara, Erin. “The State We’re In: Heroin Prescribing in the UK.” Drink and Drug News (Dec. 2015). 20 Jan. 2016 <https://drinkanddrugsnews.com/the-state-were-in-2/>.Parker, Howard, Judith Aldridge, and Fiona Measham. Illegal Leisure: The Normalization of Adolescent Recreational Drug Use. Hove: Routledge, 1998.Vitellone, Nicole. “The Rush: Needle Fixation or Technical Materialization?” Journal for Cultural Research 7.2 (2003): 165–177.

On Wednesday 21 April the Minister for Communications, Information Technology and the Arts introduced a piece of legislation into the Australian Senate to regulate the way Australians use the Internet. This legislation is presented within Australia's existing system of content regulation, a scheme that the Minister describes is not censorship, but merely regulation (Alston 55). Underlying Senator Alston's rhetoric about the protection of children from snuff film makers, paedophiles, drug pushers and other criminals, this long anticipated bill is aimed at reducing the amount of pornographic materials available via computer networks, a censorship regime in an age when regulation and classification are the words we prefer to use when society draws the line under material we want to see, but dare not allow ourselves access to. Regardless of any noble aspirations expressed by free-speech organisations such as Electronic Frontiers Australia relating to the defence of personal liberty and freedom of expression, this legislation is about porn. Under the Bill, Australia would proscribe our citizens from accessing: explicit depictions of sexual acts between consenting adults; mild non-violent fetishes; depictions of sexual violence, coercion or non-consent of any kind; depictions of child sexual abuse, bestiality, sexual acts accompanied by offensive fetishes, or exploitative incest fantasies; unduly detailed and/or relished acts of extreme violence or cruelty; explicit or unjustifiable depictions of sexual violence against non-consenting persons; and detailed instruction or encouragement in matters of crime or violence or the abuse of proscribed drugs. (OFLC) The Australian public, as a whole, favour the availability of sexually explicit materials in some form, with OFLC data indicating a relatively high degree of public support for X rated videos, the "high end" of the porn market (Paterson et al.). In Australia strict regulation of X rated materials in conventional media has resulted in a larger illegal market for these materials than the legalised sex industries of the ACT and Northern Territory (while 1.2 million X rated videos are legally sold out of the territories, 2 million are sold illegally in other jurisdictions, according to Patten). In Australia, censorship of media content has traditionally been based on the principles of the protection of society from moral harm and individual degradation, with specific emphasis on the protection of innocents from material they are not old enough for, or mentally capable of dealing with (Joint Select Committee on Video Material). Even when governments distanced themselves from direct personal censorship (such as Don Chipp's approach to the censorship of films and books in the late 1960s and early 1970s) and shifted the rationale behind censorship from prohibition to classification, the publicly stated aims of these decisions have been the support of existing community standards, rather than the imposition of strict legalistic moral values upon an unwilling society. In the debates surrounding censorship, and especially the level of censorship applied (rather than censorship as a whole), the question "what is the community we are talking about here?" has been a recurring theme. The standards that are applied to the regulation of media content, both online and off, are often the focus of community debate (a pluralistic community that obviously lacks "standards" by definition of the word). In essence the problem of maintaining a single set of moral and ethical values for the treatment of media content is a true political dilemma: a problem that lacks any form of solution acceptable to all participants. Since the introduction of the Internet as a "mass" medium (or more appropriately, a "popular" one), government indecision about how best to treat this new technology has precluded any form or content regulation other than the ad hoc use of existing non-technologically specific law to deal with areas of criminal or legally sanctionable intent (such as the use of copyright law, or the powers under the Crimes Act relating to the improper use of telecommunications services). However, indecision in political life is often associated with political weakness, and in the face of pressure to act decisively (motivated again by "community concern"), the Federal government has decided to extend the role of the Australian Broadcasting Authority to regulate and impose a censorship regime on Australian access of morally harmful materials. It is important to note the government's intention to censor access, rather than content of the Internet. While material hosted in Australia (ignoring, of course, the "cyberspace" definitions of non-territorial existence of information stored in networks) will be censored (removed from Australia computers), the government, lacking extraterritorial powers to compel the owners of machines located offshore, intends to introduce of some form of refused access list to materials located in other nations. What is interesting to consider in this context is the way that slight shifts of definitional paradigm alter the way this legislation can be considered. If information flows (upon which late capitalism is becoming more dependent) were to be located within the context of international law governing the flow of waterways, does the decision to prevent travel of morally dubious material through Australia's informational waterways impinge upon the riparian rights of other nations (the doctrine of fair usage without impeding flow; Godana 50)? Similarly, if we take Smith's extended definition of community within electronic transactional spaces (the maintenance of members' commitment to the group, monitoring and sanctioning behaviour and the production and distribution of resources), then the current Bill proposes the regulation of the activities of one community by another (granted, a larger community that incorporates the former). Seen in this context, this legislation is the direct intervention in an established social order by a larger and less homogeneous group. It may be trite to quote the Prime Minister's view of community in this context, where he states ...It is free individuals, strong communities and the rule of law which are the best defence against the intrusive power of the state and against those who think they know what is best for everyone else. (Howard 21) possibly because the paradigm in which this new legislation is situated does not classify those Australians online (who number up to 3 million) as a community in their own right. In a way the Internet users of Australia have never identified themselves as a community, nor been asked to act in a communitarian manner. While discussions about the value of community models when applied to the Internet are still divided, there are those who argue that their use of networked services can be seen in this light (Worthington). What this new legislation does, however, is preclude the establishment of public communities in order to meet the desires of government for some limits to be placed on Internet content. The Bill does allow for the development of "restricted access systems" that would allow pluralistic communities to develop and engage in a limited amount of self-regulation. These systems include privately accessible Intranets, or sites that restrict access through passwords or some other form of age verification technique. Thus, ignoring the minimum standards that will be required for these communities to qualify for some measure of self-regulatory freedom, what is unspoken here is that specific subsections of the Internet population may exist, provided they keep well away from the public gaze. A ghetto without physical walls. Under the Bill, a co-regulatory approach is endorsed by the government, favouring the establishment of industry codes of practice by ISPs and (or) the establishment of a single code of practice by the content hosting industry (content developers are relegated to yet undetermined complementary state legislation). However, this section of the Bill, in mandating a range of minimum requirements for these codes of practice, and denying plurality to the content providers, places an administrative imperative above any communitarian spirit. That is, that the Internet should have no more than one community, it should be an entity bound by a single guiding set of principles and be therefore easier to administer by Australian censors. This administrative imperative re-encapsulates the dilemma faced by governments dealing with the Internet: that at heart, the broadcast and print press paradigms of existing censorship regimes face massive administrative problems when presented with a communications technology that allows for wholesale publication of materials by individuals. Whereas the limited numbers of broadcasters and publishers have allowed the development of Australia's system of classification of materials (on a sliding scale from G to RC classifications or the equivalent print press version), the new legislation introduced into the Senate uses the classification scheme simply as a censorship mechanism: Internet content is either "ok" or "not ok". From a public administration perspective, this allows government to drastically reduce the amount of work required by regulators and eases the burden of compliance costs by ISPs, by directing clear and unambiguous statements about the acceptability of existing materials placed online. However, as we have seen in other areas of social policy (such as the rationalisation of Social Security services or Health), administrative expedience is often antipathetic to small communities that have special needs, or cultural sensitivities outside of mainstream society. While it is not appropriate to argue that public administration creates negative social impacts through expedience, what can be presented is that, where expedience is a core aim of legislation, poor administration may result. For many Australian purveyors of pornography, my comments will be entirely unhelpful as they endeavour to find effective ways to spoof offshore hosts or bone up (no pun intended) on tunnelling techniques. Given the easy way in which material can be reconstituted and relocated on the Internet, it seems likely that some form of regulatory avoidance will occur by users determined not to have their content removed or blocked. For those regulators given the unenviable task of censoring Internet access it may be worthwhile quoting from Sexing the Cherry, in which Jeanette Winterson describes the town: whose inhabitants are so cunning that to escape the insistence of creditors they knock down their houses in a single night and rebuild them elsewhere. So the number of buildings in the city is always constant but they are never in the same place from one day to the next. (43) Thus, while Winterson saw this game as a "most fulfilling pastime", it is likely to present real administrative headaches to ABA regulators when attempting to enforce the Bill's anti-avoidance clauses. The Australian government, in adapting existing regulatory paradigms to the Internet, has overlooked the informal communities who live, work and play within the virtual world of cyberspace. In attempting to meet a perceived social need for regulation with political and administrative expedience, it has ignored the potentially cohesive role of government in developing self-regulating communities who need little government intervention to produce socially beneficial outcomes. In proscribing activity externally to the realm in which these communities reside, what we may see is a new type of community, one whose desire for a feast of flesh leads them to evade the activities of regulators who operate in the "meat" world. What this may show us is that in a virtual environment, the regulators' net is no match for a world wide web. References Alston, Richard. "Regulation is Not Censorship." The Australian 13 April 1999: 55. Paterson, K., et. al. Classification Issues: Film, Video and Television. Sydney: The Office of Film and Literature Classification, 1993. Patten, F. Personal interview. 9 Feb. 1999. Godana, B.A. Africa's Shared Water Resources: Legal and Institutional Aspects of the Nile, Niger and Senegal River Systems. London: Frances Pinter, 1985. Howard, John. The Australia I Believe In: The Values, Directions and Policy Priorities of a Coalition Government Outlined in 1995. Canberra: Liberal Party, 1995. Joint Select Committee On Video Material. Report of the Joint Select Committee On Video Material. Canberra: APGS, 1988. Office of Film and Literature Classification. Cinema & Video Ratings Guide. 1999. 1 May 1999 <http://www.oflc.gov.au/classinfo.php>. Smith, Marc A. "Voices from the WELL: The Logic of the Virtual Commons." 1998. 2 Mar. 1999 <http://www.sscnet.ucla.edu/soc/csoc/papers/voices/Voices.htm>. Winterson, Jeanette. Sexing the Cherry. New York: Vintage Books. 1991. Worthington, T. Testimony before the Senate Select Committee on Information Technologies. Unpublished, 1999. Citation reference for this article MLA style: Peter Chen. "Community without Flesh: First Thoughts on the New Broadcasting Services Amendment (Online Services) Bill 1999." M/C: A Journal of Media and Culture 2.3 (1999). [your date of access] <http://www.uq.edu.au/mc/9905/bill.php>. Chicago style: Peter Chen, "Community without Flesh: First Thoughts on the New Broadcasting Services Amendment (Online Services) Bill 1999," M/C: A Journal of Media and Culture 2, no. 3 (1999), <http://www.uq.edu.au/mc/9905/bill.php> ([your date of access]). APA style: Author. (1999) Community without flesh: first thoughts on the new broadcasting services amendment (online services) bill 1999. M/C: A Journal of Media and Culture 2(3). <http://www.uq.edu.au/mc/9905/bill.php> ([your date of access]).

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.

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>.

The Children’s Aid Society’s concept of community schools came to life in February 1992 with the opening of the Salomé Ureña de Henriquez Middle Academies (Intermediate School [IS] 218) and the opening in March 1993 of the Ellen Lurie School (Primary School [PS] 5). These were the first community schools operated by The Children’s Aid Society (CAS) in partnership with New York City’s Board of Education. PS 5 is an elementary school whose students advance to middle school at IS 218. The model has evolved into a well-integrated, multidimensional community school involving CAS, the Board (now Department) of Education, and the parents and many other partners from the broader community. Before the two schools opened, several years were spent in preparation and planning. Initially, CAS surveyed New York City communities to identify those that would benefit most from CAS’s services. This was part of an ongoing effort on CAS’s part to examine its current programs in order to modify them to meet current social and familial needs. The survey led to the selection of the Washington Heights community, which was characterized by a large influx of recent immigrants, substantial poverty, large families, and a dearth of services. A more intensive study conducted by CAS in 1987 had documented the dramatic needs of families in this community and the shortage of services available to them. The school system ranked 32nd of 32 districts in nearly every category. The type of poverty that characterizes new immigrants was endemic: very low-wage jobs, two and three families sharing one apartment, and a reluctance to accept outside help. Washington Heights was the substance- abuse and drug-trafficking hub for the tri-state area and had the city’s highest homicide rate. Teenage pregnancy rates were also among the city’s highest. This community is not unlike those that CAS has traditionally served throughout its 150-year history. What was to be strikingly different was how CAS would address these problems. In setting out to plan a service model, CAS drew on its long and rich history of operating community centers in low-income neighborhoods.