Partner Agencies Research Articles

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Exploring gender norms, agency and intimate partner violence among displaced Colombian women: A qualitative assessment

Women displaced by conflict are often exposed to many factors associated with a risk of intimate partner violence (IPV) such as high levels of community violence and the breakdown of social support systems. Previous research found that Colombian women perceived IPV to increase after displacement. This study explored how the experience of displacement altered gendered roles in ways that influenced the risk of IPV. Thirty-three qualitative interviews were conducted with displaced partnered Colombian women. Women disclosed that couples often held patriarchal gender norms; however, the roles of each partner necessitated by conditions of displacement were often in conflict with these norms. Men's underemployment and women's employment outside the home were viewed as gender transgressive within some partnerships and increased relationship conflict. Economic resources intended to empower displaced women, notably women's earnings and home ownership, had unintended negative consequences for women's agency. These consequences included a corresponding decrease in partner financial contributions and reduced mobility. Women's ability to obtain support or leave violent relationships was hindered by interpersonal, social and structural barriers. For women to have agency to leave violent relationships, power relationships at all levels from the interpersonal to societal must be recognised and addressed.

A San Francisco Bay Area CBPR Training Institute

The rapid increase of community-based participatory research (CBPR) as an approach to research underscores the importance of expanding access to training in CBPR principles and strategies. CBPR is increasingly recognized as a collaborative approach that can reduce health disparities through building on the strengths of each partner and using scientific knowledge for health action. However, there is a need to increase access to CBPR training for academics, public health professionals, and especially underserved communities that may benefit significantly from new collaborative research projects. This article reports on the efforts of a regional CBPR training consortium in the United States to develop, implement, and evaluate a 5-day CBPR training curriculum tailored to a diverse audience of public health practitioners, academics, students, and community members. The conference goals were to create partnerships and networks for designing, implementing, and evaluating CBPR projects and to identify ways to integrate knowledge from academic, agency, and community partners. The curriculum addressed the following core daily themes: Creating, Building, and Maintaining Partnerships; Collaborative Study and Intervention Design; Collaborative Data Collection, Analysis, and Dissemination; The Intersection of CBPR, Policy, and Social Change; and Fundraising and Sustainability for CBPR. The CBPR curriculum achieved its goal of expanding access to CBPR training for diverse stakeholders in the area, including those from underserved communities and developing a training curriculum with the potential for replication in other locations nationally and internationally. Lessons learned from the implementation and evaluation of the training are shared.

The role of youth engagement in positive youth development and social justice youth development for high-risk, marginalised youth

This article describes reflective experiences documented by our youth leaders and community agency partners (n = 7 & 12, respectively) who have involved in our multi-year community-based research project. Overall, meaningful youth engagement facilitated by youth leadership was highlighted as a key mechanism for positive youth development (PYD) and social justice youth development (SJYD). First, the key PYD-related concepts identified include the following: (1) strengths-based empowering approach to youth engagement, (2) capacity building and positive outcomes for youth and youth-serving agencies and (3) youth-oriented, collaborative research processes that enable the promotion of these positive outcomes (e.g. honouring youth voice: ‘bottom-up process for youth by youth’). Second, the key SJYD-related concepts identified were as follows: (a) activating the voice of youth for social/system change, and (b) advancing research into action – knowledge translation and practical application. The contributions of our youth leaders to youth engagement were shown to be vital to promoting PYD and SJYD.

Development and piloting of a treatment foster care program for older youth with psychiatric problems.

BackgroundOlder youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes.MethodsA team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes.ResultsDevelopment efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles – that of psychiatric nurse and skills coaches – very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities.ConclusionsThe intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important supports for older youth with psychiatric needs.

Building Agency Capacity for Trauma-Informed Evidence-Based Practice and Field Instruction

Through this article the authors describe how schools of social work offering a child and adolescent trauma specialization actively partnered with their community-based field placement agencies to achieve a dual purpose: help agencies sustain the capacity for evidence-based trauma treatment (EBTT) and provide sufficient EBTT MSW student field placement sites that support preparation of trauma-informed practitioners by schools of social work. Development and description of the specific conceptual framework used to inform the trauma-informed organizational change initiative is described. Results of an Organizational Readiness assessment undertaken at six agencies reflect a strong alignment between implementation drivers identified in the literature (Fixsen, Blase, Naoom, & Wallace, 2009) and the conceptual framework. The manner in which these results are being used by schools of social work and their agency partners in sustaining the implementation of evidence-based trauma treatment is reviewed, and implications for future research, education, and practice is discussed.

“When we say ‘urgent’ it means now …”

Purpose – The purpose of this paper is to describe the perceptions which senior health and social care leaders have of their own organisations and of partner agencies, illustrating a possible method for beginning to think and talk about organisational and professional culture in settings. Design/methodology/approach – This is a practical case study, with a group of senior leaders from across the health and social care system. Findings – Different groups were often more critical of their own organisations than of others, but could still identify certain characteristics that they associated with partner agencies. While there is much that we admire about ourself and others, we seldom get chance to share this positive feedback. Equally, we rarely have the scope to give each other more challenging feedback and this – when carefully facilitated – can help build stronger relationships in the longer term. Research limitations/implications – Inter-agency working is often influenced by the implicit assumptions and stereotypes we hold about each other’s professional culture. Surfacing these in a safe, facilitated setting can help to explore and challenge such assumptions (where appropriate), reflect on how we see others and better understand how others see us. Originality/value – Policy debates about integrated care too often focus on structural “solutions” and arguably pay insufficient attention to the importance of culture. While work with front-line practitioners often tries to explore different perceptions of each other, it is less common for such an approach to be attempted with senior leaders.

The joint interagency task force and the global steering committee for the quality assurance of health products: two new and proactive approaches promoting access to safe and effective medicines.

Financing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria1 support programs run by local experts in countries and communities that most need funding. Those programs help to save lives every day. However, expanding access to medicines on a global scale can face challenges posed by falsified, substandard, stolen, and diverted medicines. The Joint Interagency Task Force (JIATF) is an initiative that offers a new, proactive, and intelligence-led approach to safeguarding the delivery of quality medicines for major donor organizations and protecting public health by identifying falsified medicines in countries where they appear. By also focusing on the issue of stolen and diverted medicines, JIATF provides an important assurance mechanism. A core focus area of the Global Fund component of JIATF (GF-JIATF) is its National Engagement Strategy (NES), which serves as a launch pad to develop partnerships and provide training and logistical support to partners within a country's national drug regulatory and law enforcement community. This national system strengthening compliments and augments health systems strengthening overall. Through its work, GF-JIATF is assisting its drug regulatory agency and law enforcement partners at the national level to identify vendors engaged in the trade of illicit medicines, providing support to successful enforcement operations and helping to disrupt those criminal networks engaged in this trade. These outputs promote better public health outcomes by removing falsified products from circulation. Through a carefully developed framework of data collection and analysis, its NES, and the establishment of a broad coalition of international partnerships, the GF and its fellow core members in JIATF are helping to protect drug quality as an integral part of their organization's core mission to expand access to safe and effective medicines. The GF is also a founding member and the Secretariat for the Global Steering Committee (GSC) for quality assurance of health products, which is a voluntary coalition of health development institutions focused on improved access to safe and effective medicines and chaired by Norbert Hauser, the chair of the GF Board. Current Core membership of GSC includes Gavi, the Global Fund, the United Nations Development Program (UNDP), UNITAID, the U.S. Presidents Malaria Initiative (PMI), the U.S. Agency for International Development (USAID), the U.S. Food and Drug Agency, the World Bank, and the World Health Organization (WHO). Inaugurated in November 2014, the GSC will harness the collective efforts of multilateral and bilateral organizations, national authorities, nongovernmental organizations (NGOs), and drug companies to facilitate an enhanced assurance framework for both quality and supply chain integrity of health products.

The Role of Libraries in Contemporary African Society

The focus of this paper is on library development in contemporary African society. A discussion of library development in the context of countries now enjoying rapid economic development is attempted here. Focusing on countries undergoing rapid economic development brings an alternative perspective to an analysis of library development in Africa and helps us to understand not only what is lacking but also what is going well as a basis for future development. The paper is divided into three parts: one that considers the contemporary landscape of librarianship in Africa; one that describes the characteristics of African society; and one that concerns the major role that information and communication technologies (ICTs) have played in the renaissance of libraries in Africa. Several drivers of change in African library development stand out—most notably: 1) the achievement of stronger economic circumstances; 2) the increased prevalence of ICTs and access to the internet; 3) expanded public awareness of the value of libraries in society; and 4) partnership between the new generation of government leaders and partner agencies that are more focused on social impact than maintaining influence and dominance.

Multi-agency action learning: Challenging institutional barriers in policing and mental health services

The police have underdeveloped links with mental health and social care services despite daily contact with mentally ill individuals. They struggle with identifying and managing the mentally ill in custody, and consistently express a lack of support from partner agencies. In 2010, our research team developed a mental health screening tool and pathway for use by police custody officers, The Police Mental Health Screening Questionnaire (PolQuest). However, due to the large number of agencies with different organisational goals and responsibilities that deal with mentally disordered offenders, the introduction of a screening tool alone was considered insufficient. Thus, an action learning group comprising key professionals from relevant services in one geographical area was tasked with developing a manual and training materials to support the implementation of PolQuest by frontline staff. This paper reflects upon the key themes that emerged from the experience of action learning as a method for engaging multi-agency staff, operating under different occupational goals and cultures, to develop shared practice-oriented outcomes. Data analysed include the facilitator’s reflective notes, meeting minutes and emails. The action learning process was considered a useful method for engaging multi-agency stakeholders in developing materials to support PolQuest’s implementation in vivo.

EnhanceFitness: A 20-Year Dissemination History.

EnhanceFitness: A 20-Year Dissemination History.

Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group's experience

IntroductionPan American Health Organization's (PAHO) ProVac Initiative aims to strengthen countries’ technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative's tools and methods to support decisions in non-PAHO regions. MethodsIn 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. ResultsFifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. DiscussionDeveloping countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. ConclusionDecision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs.

Supporting Postsecondary Education Programs for Individuals With an Intellectual Disability

As postsecondary education (PSE) programs for individuals with an intellectual and developmental disability (IDD) emerge across the country, it is crucial that these programs involve adult agency partners to enhance planning and service delivery, thereby increasing the likelihood that the skills obtained during these experiences will lead to improved employment outcomes. The present study aims to extend the current knowledge base regarding PSE programs’ and vocational rehabilitation (VR) agencies’ collaborative roles and activities. The present study examines state VR involvement with PSE programs as perceived by PSE administrators, specifically, the extent to which PSE and VR are collaborating, and the roles and activities rehabilitation counselors perform during this collaboration. Findings indicate that PSE administrators report variability in both the levels of collaboration with state VR agencies and the understanding of VR roles. Furthermore, data show that the majority of respondents felt VR seldom or never provide services beyond financial assistance. Implications for research and practice are also discussed.

Services to domestic minor victims of sex trafficking: Opportunities for engagement and support

Human trafficking of young people is a social problem of growing concern. This paper reports selected findings from an evaluation of three programs serving domestic minor victims of human trafficking. Participants in this study were funded to identify and serve male and female victims of sex or labor trafficking who were less than 18years old and were U.S. citizens or lawful permanent residents. Programs provided case management and comprehensive services, either directly or through community collaboration. Evaluation data included data on client characteristics, service needs and services delivered; key informant interviews with program staff and partner agencies; and case narrative interviews in which program staff provided in-depth descriptions of clients' histories. All clients served were known or believed to be sex trafficked. The majority of clients needed crisis intervention, safety planning, educational support, mental health services, and employment services. Although they were diverse in terms of demographics and circumstances, two common patterns were of homeless young people exchanging sex to meet survival needs and young people were emotionally engaged with their trafficker. Key findings include the diversity of trafficked minors, the challenge of initial and continued engagement with service delivery, the structural and resource barriers to long-term support for young people, and the potential contribution of programs specifically addressing trafficked minors. A framework linking services to young people's circumstances and outcome areas is proposed.

Water and Energy nexus: findings of the World Water Development Report 2014

Abstract. The post-2015 Sustainable Development Goals (SDG) are likely to include increased access to water and energy services. The fifth edition of the United Nations World Water Development Report (WWDR) Water and Energy aims to contribute to the this international process by informing the decision-making about the interlinkages, potential synergies and trade-offs as well as by stressing the need for appropriate responses and regulatory frameworks that account for both water and energy priorities. The Report provides a comprehensive and up-to-date overview of the impacts of ever-increasing energy production on water resources and water users, including agriculture, rapidly expanding cities, expanding industry and the environment. It analyses major and emerging trends from around the world, with examples of how some of the trend-related challenges have been addressed, their implications for policy-makers, and further actions that can be taken by stakeholders and the international community. As the first of a new series of theme-oriented reports to be released on an annual basis, the WWDR 2014 marks a pivotal new direction for the WWDR series, for the World Water Assessment Programme (WWAP), and the many partner agencies that contribute substantially in the production of the flagship report of UN-Water.

Climate change and vector-borne diseases: what are the implications for public health research and policy?

Vector-borne diseases continue to contribute significantly to the global burden of disease, and cause epidemics that disrupt health security and cause wider socioeconomic impacts around the world. All are sensitive in different ways to weather and climate conditions, so that the ongoing trends of increasing temperature and more variable weather threaten to undermine recent global progress against these diseases. Here, we review the current state of the global public health effort to address this challenge, and outline related initiatives by the World Health Organization (WHO) and its partners. Much of the debate to date has centred on attribution of past changes in disease rates to climate change, and the use of scenario-based models to project future changes in risk for specific diseases. While these can give useful indications, the unavoidable uncertainty in such analyses, and contingency on other socioeconomic and public health determinants in the past or future, limit their utility as decision-support tools. For operational health agencies, the most pressing need is the strengthening of current disease control efforts to bring down current disease rates and manage short-term climate risks, which will, in turn, increase resilience to long-term climate change. The WHO and partner agencies are working through a range of programmes to (i) ensure political support and financial investment in preventive and curative interventions to bring down current disease burdens; (ii) promote a comprehensive approach to climate risk management; (iii) support applied research, through definition of global and regional research agendas, and targeted research initiatives on priority diseases and population groups.

Spotlight on Express Lane Eligibility (ELE): A Tool to Improve Enrollment and Renewal

ObjectiveWe examine a new simplification policy, Express Lane Eligibility (ELE), introduced by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), to understand ELE's effects on enrollment, renewal, and administrative costs. MethodsBeginning in January 2012 and lasting through June 2013, we conducted 2 rounds of phone interviews with 38 state administrators and staff in 8 states that implemented ELE in Medicaid, Children's Health Insurance Program (CHIP), or both; we also conducted case studies in these same states, resulting in 136 in-person interviews. We collected administrative data on enrollments and renewals processed through ELE methods from the 8 states. ResultsELE was adopted in different ways; the method of adoption influenced how many children were served and administrative savings. Automatic ELE processes, which enable states to use eligibility findings from partner agencies to automatically enroll or renew children, serve the most children and generate, on average, $1 million annually in administrative savings. Given the size of renewal caseloads and the recurring nature of renewal, using ELE for renewals holds substantial promise for administrative savings and keeping children covered. ConclusionsAutomatic ELE processes are a best practice for using ELE. However, because Congress has not yet made ELE a permanent policy option, states are discouraged from adopting this more efficient method of eligibility determination and redeterminations. Making ELE permanent would support states that have already adopted the policy; in addition, ELE could support the transition of children to Medicaid or exchanges should CHIP not be funded after September 30, 2015.

The Risk Environment of Heroin Use Initiation: Young Women, Intimate Partners, and “Drug Relationships”

This paper examines young women's initiation to heroin use in the context of an intimate relationship based on data from a small-scale ethno-epidemiology of heroin use in Ireland, 2007–2009. The epidemiological sample included 120 young people, and life history interviews were conducted with a sub-sample of 40 youth aged 16–25 years. A detailed analysis of the “risk environment” of young women's heroin initiation highlights a complex interplay between women's agency and intimate partner influence. It is argued that dichotomous representations of women as victims or emancipated consumers do not adequately capture the complexity of women's initiation journeys. The study's limitations are noted and implications for drug use prevention and harm reduction strategies are discussed.

Practitioner Toolkit: Getting It Right for Children and Families Affected by Parental Problem Alcohol and Drug Use by Anne Whittaker with Lorna Templeton, Fiona Mitchell, Louise Hill and Anne Neilson, NHS Lothian and partner agencies, 2014. Available free: http://www.nhslothian.scot.nhs.uk/MediaCentre/Publications/ForProfessionals/ProtectingChildren/PRACTITIONERs%20TOOLKIT%20July%202013.pdf

Parental substance misuse and its impact upon children and families has been widely researched and documented over the last ten years. We have estimates of the scale and impact of the problem, starting with the ground-breaking inquiry into the children of problem drug users by the Advisory Council on the Misuse of Drugs (2003), which made 48 recommendations for policy and practice. In 2009, Manning et al. published new estimates of the numbers of children affected. Then, in 2012, Adamson and Templeton's Silent Voices highlighted that the prevalence, identification and response to these children and young people are fundamentally unknown. Only in recent years have attempts been made to equip the workforce with the knowledge, skills and resources to reduce the impact of problem drug and alcohol use upon children and families, by promoting resilience and working with the whole family. Scotland has been at the forefront of addressing parental problem drug and alcohol use, and Getting it right for every child (The Scottish Government, 2014) provides an integrated strategy and effective operational approach, also recommended in a recent report from The Children's Commissioner for England (Manning et al., 2014). This consistent approach supports all practitioners in focusing on what makes a positive difference for children and young people, and what they can do to deliver these improvements. ‘Scotland has been at the forefront of addressing parental problem drug and alcohol use’ The introduction to the toolkit states that it is designed for any practitioner involved in the assessment and care of children, parents, families and family members affected by parental problem drug and alcohol use; that it aims to complement local and national strategies, interagency guidelines and good practice guidance; and, most importantly, that it responds to feedback from local practice and the need and desire for tools and resources. ‘Specific guidance on this topic is needed because parental problem alcohol and drug use is associated with social, legal, economic, and health-related problems that often complicate the delivery of care to these families. Much co-ordination and understanding between professionals and agencies is often needed.’ (p. 5) ‘Significant and of huge relevance to the range of practitioners it seeks to engage, support and develop’ This online resource is well structured with four core components covering: (1) assessment, (2) care planning, (3) action/implementation and (4) evaluation/review of care plans, which are all pertinent regardless of whom the practitioner is working with in the family. Each core component is filled with practice points, case studies, recommended reading and checklists which are clear, appropriate and useful for practitioners in their day-to-day work, but more importantly based upon current best practice and evidence. I am particularly heartened by the fact that the toolkit promotes a value-based system of care with a particular emphasis on keeping the child at the centre, recognising that these families often experience stigma, that substance misuse generally does not appear in isolation and the importance of working with the whole family. ‘Promotes a value-based system of care’ The resource is intended to enhance the knowledge and skills of health and social care practitioners and to support their continuing professional development, both of which are known to be essential for this often complex and challenging work. The addition of a learning and development plan or questionnaire would help to clarify how the resource is expected to meet these aims. I am struggling to find anything negative to say about this resource other than raise the question of how it will be kept up to date. There is a definite need for such a resource and I would welcome something similar in England, although there is useful and transferable information in this toolkit already and I know that practitioners in England will be very eager to access it. ‘There is a definite need for such a resource and I would welcome something similar in England’

Introduction

When Edward Snowden, on June 9, 2013, revealed his identity in a video interview posted on the website of the Guardian, he invoked the intellectual framework of liberalism in order to explain why he had leaked a massive trove of secret documents about the spying and data collection practices of the National Security Administration (NSA) and its partner agencies. Having regularly witnessed the legal abuses of the NSA as a technical assistant for the CIA and, subsequently, as an employee of the defense contractor Booz Allen Hamilton, Snowden explained that “over time [the] awareness of wrongdoing builds up and you…