Civil society,the market and democracy in Latin America

‘Civil society’ has been used in a confusing variety of ways in Latin America by academics, policy‐makers, non‐governmental organizations and activists. This article explores the ambiguities in the usages of the concept over the last decade in a bid to rescue it from the danger of abandonment for having become all things to all people. If used rigorously, the concept remains a useful analytical tool for exploring the process and progress of democratization and capitalist development in Latin America. It encourages us to ask what difference a vibrant associational life can make to building more inclusive and sustainable democracies in Latin America. The case of Chile is used as an example of how ‘civil society’ opens up new questions for research in a country which many hail as the most successful example of economic and political liberalization in Latin America.     

Outcome measurement in forensic mental health research: an evaluation

Abstract

Measuring change resulting from healthcare interventions is critical to evaluating their usefulness. The choice of outcome measure is an important part of such evaluations and is driven by assumptions about what is likely to change and how best to capture this. Despite its importance, forensic mental health has paid little attention to determining which are the best measures of outcome. This study used a panel of relevant professionals to (i) assess the relative importance of different areas of potential outcome measurement and (ii) evaluate specific instruments used currently as outcome measures in forensic mental health research. Although a wide range of potential outcomes were endorsed as appropriate, few corresponding instruments have been used consistently. Only three psychiatric instruments deemed by our panel as feasible, relevant and psychometrically adequate have been used in five or more studies (the Beck Depression Inventory; the Brief Psychiatric Rating Scale, and the Symptom Checklist-90–Revised). Significant measurement gaps were noted in areas such as social and emotional functioning. Although instruments exist that could capture most areas, none were sufficiently developed for routine use as outcomes. Further research to develop robust, sensitive and diverse outcome measures is needed. This is an essential precursor to extending the evidence base for forensic mental health interventions.     

Collaborative Governance in the Reform of Western Australia's Alcohol and Other Drug Sector

Collaborative governance involves processes and structures for policy development and decision making with particular relevance for health and social services. We examined collaborative governance in the reform of Western Australia's alcohol and other drug sector, applying Emerson et al.'s (2012) integrative framework. A documentary review and group interviews with government, sector, and consumer representatives were involved. Contextual factors included increased service funding, and the development of a partnership approach. Drivers for collaboration involved leadership and financial incentives for policy implementation. Key stakeholders across government and the sector reported a mutually supportive and constructive relationship and increased capacity, and they shared an agenda for change. The integrative framework was a useful structure for the explication of collaborative governance, although financial arrangements were not addressed.     

The development of the comprehensive health assessment tool for young offenders within the secure estate

Health inequalities are high among offending groups. The comprehensive health assessment tool (CHAT) is a semi-structured assessment developed to provide a standardised approach to health screening for all young offenders admitted to the secure estate. The four sections of the CHAT (physical health, mental health, substance misuse and neurodisability) were evaluated within a two-phased study of male adolescents (aged 15–18?years) within a young offenders institution in the north-west of England. Within Phase 1, a consecutive sample of 127 new receptions was assessed using the physical health, mental health and substance misuse sections of the CHAT against a range of reference standard assessments. Phase 2 of the study evaluated the neurodisability section on 93 male adolescents against reference standard tools. The four sections of the CHAT demonstrated fair to good convergent validity when compared against reference standard tools in male offenders. The diagnostic accuracy rate was 76% for mental health, 63% for physical health, 83% for substance misuse and 53% for neurodisability when compared against reference standard assessment tools. The introduction of the CHAT offers the opportunity to enhance existing reception screening practices and create an integrated approach to the assessment of health needs across the secure estate.     

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.     

No visible difference: a women's empowerment process in a Cambodian NGO

The lives of female Cambodian NGO staff are characterised by the contradictions of apparent freedom and multiple invisible constraints on their behaviour and choices. An empowerment process facilitated by an expatriate did not produce the expected responses of sisterhood and group action. Through a series of workshops, learning emerged about the context-dependent nature of concepts of empowerment, and the irrelevance of many Western models for other cultures. Fear and mistrust, rooted in both traditional culture and the post-conflict context, are powerful and profound blocks to change in women's lives. No visible difference in workplace behaviours appeared after the empowerment process. However, the women responded to new insights about their lives, beliefs, and culture in ways that had meaning for them; and they reported significant benefits for family and social relationships.     

Policy on innovation in Australia: Divergence in definitions,problems, and solutions

Innovation has joined the mainstream in many nations as governments search for new ways to tackle challenging societal and economic problems. But Australia is seen to be lagging on innovation policy. Is this related to how governments define innovation? What do they regard as the problem they are addressing? What proposed solutions follow from this? This paper examines how Australian governments have defined innovation over four decades, signalling their policy intentions about how to make the nation more innovative. Definitions of innovation are analysed using 79 Australian (national level) policy documents published from 1976 to 2019. Close reading of these documents suggests two main definitions: innovation as technology, and innovation as culture. Topic modelling uncovers more differentiated themes, shows how definitions change over time, and demonstrates an association between definitions and political parties in government. The divergent approaches suggest a lack of coherence and continuity to policy on innovation in Australia.

Points for practitioners

• Innovation has expanded and broadened in its definition and governments and policymakers have paid increasing attention to it.
• In Australia, there are two main definitions of innovation used in policy—one related to technology and one related to culture.
• The technology view of innovation can be further divided into a focus on businesses or a focus on research and development (R&D).
• Different innovation definitions, problems, and solutions dominate at different times, with Coalition governments tending to favour business and technology over culture, and Labor governments doing the opposite.
• There are divergent approaches to policy on innovation in Australia which suggest a lack of coherence and consistency in policy over the long term.