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Review Article | DOI: https://doi.org/10.31579/2690-4861/880
New South Wales, affiliated with Australian Breastfeeding Association, Recently and since 1983 Counsellor/Trainer and Assessor.
*Corresponding Author: Susan Anne Smith, New South Wales, affiliated with Australian Breastfeeding Association, Recently and since 1983 Counsellor/Trainer and Assessor.
Citation: Susan A. Smith, (2025), Moral Enhancement and Complexity as Community-based Organizations Supporting Immigrants: A Narrative Review, International Journal of Clinical Case Reports and Reviews, 28(2); DOI:10.31579/2690-4861/880
Copyright: © 2025, Susan Anne Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 12 June 2025 | Accepted: 27 June 2025 | Published: 26 July 2025
Keywords: VET; changing populations; moral agency; moral enhancement; breast milk; volunteers
The ongoing migration for increased fertility in sociocultural groups can be an isolating factor for new immigrants, who may benefit from government welfare through community-based programs and organisations, such as Vocational Education and Training (VET) initiatives. The government's increasing reliance on public, private, and community-based services. Moreover, nonprofit organizations have not kept up with changing populations. Migration is a global phenomenon in many countries, characterised by birth rates below replacement levels. Can virtue ethics as practical wisdom necessarily occur? The discussion focuses on VET training and the need for change as populations change. Critical Realism is an emergent need as complex as health research. Neoliberalism has been beneficial in highlighting the interconnections between health promotion policy and practice and the larger social, cultural, and political systems of governance in which health discourses operate in societies. Learning over time can be a cultural norm as people congregate together to develop the ability to make contextually sensitive judgements. Social partnership literature adds psychological values to the notions of emergent and complexity theories. RTO volunteers confirm the need for motivation and learning as we do.
Australia has a larger immigrant population than many other industrialised countries, resulting in diverse sociocultural groups (ABS, 2018). Migration supports the fertility of Australia's population as birth rates have declined (ABS, 2024). Migrant sociocultural clustering by language can isolate a community, leading to issues surrounding the individual needs of immigrant women breastfeeding. Breastfeeding has numerous well-known benefits for both babies and their mothers. Studies suggest that breastfeeding postnatally is limited in many European countries. Another suggests that "interventions are needed at multiple levels to overcome racism"(Johnson et al., 2015, p. 18). Others state in the United States that minority populations have low breastfeeding rates (Jones et al., 2015). Another study argues that Plagiarism is "The idea of the migrant becoming 'just-like-us' signals the soft yet decisive and divisive practices of accumulating whiteness as property" in Vocational Education and Training [VET] (Webb & Lahiri-Roy, 2019, p. 355). Others suggest inconsistent breastfeeding practices across ethnic groups (Lutenbacher et al., 2016). Thus, Exclusive breastfeeding in the first six months, as recommended by the World Health Organisation (WHO, 2018, p. 4), self-help "occurs in Southern Asia at 60% and East and Southern Africa at 57% and increasing breastfeeding is successful with peer support and health professional input" (Rodriguez-Gallego et al., 2021, p. 16). Therefore, we move to self-help in neoliberalism welfare. This article will elaborate on the issue of neoliberalism, enriching the discussion by exploring how neoliberal thought and practice shape health promotion.
Government needs for private social welfare: neoliberalism.
Since the 1970s, changes have occurred in Australia in the provision of social welfare assistance through government reforms of tax and welfare systems. These shifts involve self-help as “private social welfare provision, underpinned by government policies based on neoliberalism, which is rooted in nineteenth-century neoclassical economic theory developed by Friedman (1994) and later promoted in microeconomics by the Chicago School" (Quiggin, 2022, p. 242). According to neoliberalism, in a market-driven economy, government agencies and their political interventions efficiently allocate societal resources (Quiggin, 2022). Others state neoliberal restructuring in Australia has pioneered much of the third sector. Thus, transitioning to a 'user-pays' paradigm reflects that self-help is "a government's increasing reliance on services from public, private, community-based, nonprofit organizations" (Clemans & Rushbrook, 2011, p. 284). However, "neoliberal restructuring of economies has resulted in capitalized Economies leading to universal adult workers" (Turnbull et al., 2022, p. 24). Others argue that "neoliberalism has greater inequality affecting civil society and a lower quality of lifestyles" (Western et al., 2016, p. 404). Others have suggested that health needs in mixed populations "include philosophical and spiritual values" (Workman et al., 2021, p. 47).
Methodology
Thus, migration at working age in Australia, the United States, and Canada has a lower birth rate than replacement. (Vollset et al., 2020, p. 1286). We ask, is virtue ethics, as practical wisdom, necessary for volunteer work? (De Caro et al., 2024, p. 908). Thus, plans, hopes, and ideals that shape intentionality, as moral health care (Hager & Beckett, 2024, p. 410). We turn to Critical Realism Philosophy.
Critical Realism Philosophy
Critical Realism is a philosophical system that Bhaskar developed initially as a metatheory. It has been critiqued and modified by many and applied across various disciplines, with implications for researchers. Hager et al. (2012, p. 30) A review of Critical Realism is critical, as it states that "social structures have emergent entities that cannot be prior, with causal powers persisting among the individuals involved in their emergence." Nevertheless, the philosopher Roy Bhaskar's Critical Realism aims at "objects or phenomena that need change or are to become another object or phenomenon" (Elbanna et al., 2019; Scott, 2010). Self-help is a Foucauldian governmental perspective that primarily informs Australia's neoliberal rationality in critical health promotion analyses, highlighting the interconnections between health promotion policy and practice and the larger social and cultural context. However, beyond referential illustrations of neoliberal ideology, there has been little elaboration on how the logic of neoliberalism specifically contributes to shaping contemporary health promotion policies and facilitating the modern health-conscious movement. We turn to volunteering to address government needs.
Neoliberalism and Volunteering
VET began adhering to the Australian Quality Training Framework (AQTF), an agreement between state governments initiated in 1994, which provided incentives for accrediting volunteers within their organisations. For instance, mandated volunteers aimed to increase training to establish a duty of care, a legal concept defined by the federal government (Elbanna et al., 2019). The 1960s were a time of change and confidence, as "learners became the focus for educators as the rise of humanistic psychology and alternative therapy movements" took place (Foley, 2020, p. 44). Hager and Halliday (2006, p. 249) state that learning "develops the ability to make contextually sensitive judgements as one becomes." We turn to understanding personality and traits.
Discussion Of Personality and Trait
Some suggest that personality traits associated with women’s breastfeeding include agreeableness, extraversion, and conscientiousness (Yadollahi et al., 2024, p. 9). Others agree that the "traits as individuals for best learning times" (Amir & McAuliffe, 2020, pp. 438, 474). Critically, they define the five models as "openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism." Others take a cross-cultural view, as "evolutionary and developmental theories suggest that parental protection, rather than being a cognitive instruction, is driven by their emotions and relational processes, which anticipate future threats" (Stern et al., 2022, p. 398). Thus, learning over time is "cultural norms as people congregate in groups" (Amir et al., 2020, p. 474). Therefore, communities of practices of volunteers are "pre-existing discursion, the material-economic and socio-political arrangements enable or constrain practices"(Tennant, 2020, p. 101), assuming circumstances separate from everyday practices. Thus, learning can be "the Hermeneutic seeking to interpret behaviour and stimulate insight, awareness, and understanding to engage in a reflexive dialogue with students" (Tennant, 2020, p. 171). We turn to Attachment theory and Moral resilience in health care.
Attachment Theory and Moral Enhancement
According to May and Kumar (2018, pp. 152-170), "Physiological responses are linked to reasoning, learning, and decision-making." Thus, "problem-solving change focuses on respecting scientific values, and close attention to the cognitive process is crucial for reframing actual or distorted perceptions of the world." Therefore, the "debate on attachment theory aims to demonstrate that sensitivity to babies' needs varies across cultures, all striving to meet them responsibly" (May et al., 2018, p. 170). Furthermore, non-western families are a "socialize of an infant nesting within their parents and kin groups" (Keller, 2018, p. 11418). "Moral attributes are open to influencing" (Persson & Savulescu, 2019, p. 814). Thus, "moral agency in health care practices is a dynamic inter-relational process by moral sensibility as awareness of the moral implication in deciding on behalf of another, where moral action is a personal and professional reflection as justification and accountability for decision making" (Lützén & Ewalds-Kvist, 2013, p. 4). Others debate Wiseman (2018), who argues for "social and environmental factors linked to neurobiology as hard Moral enhancement" (Earp et al., 2018, p. 168). According to Battrey (2018, pp. 162-164), "Hard moral enhancement is fantastical in scientific terms and culturally and politically in liberal democracies, while soft Moral enhancement is a growing reality, not only in psychiatric treatments for unwanted behaviour but also in campaigns, laws, and taxes that promote public health and personal conduct" (Battrey 2018). Therefore, Keller (2018, p. 11418) states that the value of "attachment theory has moved beyond the multiplicity of various moral standards." Thus, attachment theory has a sensitive response to moral judgment about its quality. Others suggest that "childhood is a time of active learning, influenced by the parents and cultural influences they encounter" (Earp et al., 2018, p. 168). Others say breastfeeding needs early support to be motivated (Page et al., 2025). As Earp et al. (2018, p. 168) state, "change is part of an individual's moral development, resulting in a morally better person." The definition is functional. It possesses "cognition, vision, hearing, and alertness, which enable to perform actions." However, can we be self-motivated? For example, Robertson (2017, p. 6) argues that "individuals enact genetically and culturally that is underpinned by sequences of triggering attributes." The other definition of agentic is "acting on moral beliefs that require reflection, reasoning applied to moral issues, and being sensitive, thus empathizing with the needs that moral theory addresses" (Earp et al., 2018, p. 169). A the further argument is that one knows or identifies whether "consciously or unconsciously, it is desirable to feel empathy, allow it to shape one's outward behaviour, or suppress feelings" (Earp et al., 2018, pp. 170-171). Others debate whether the action of wisdom (Phronesis) models need systematic theory or philosophy (Darnell et al., 2022). However, "moral reasoning and moral action as a purpose flourishes in seeing the big picture in counselling" (Han, 2022). Flourishing means moving beyond Aristotle's theory of "individuals to awe-inspiring moral ideals"(Kristjánsson, 2019, p. 165). "As flourishing and needing a positive perspective of well-being from others." "The intellectual virtue of wisdom is related to moral virtues such as decision-making, humility and reflection on social issues and people's experiences" (Nusbaum & Schneider, 2020, p. 1). Therefore, there is a need to understand community care models within sociocultural contexts.
Communities Of Care in Sociocultural Backgrounds
The neoliberal paradigm can be seen as "contractualism," referring to public/private and volunteer resourcing arrangements that differ from those of the first, second, and third sectors—at the same time, volunteering as a part of the third sector," as noted by Seddon et al. (2004, p. 139). The contractualism paradigm is the "fourth sector as a 'co-responsibility' and shared obligation" (Alessandrini, 2010, p. 125). Thus, mutual obligations lead to curbing government spending and promoting economic efficiency through the involvement of nonprofit volunteers. Governments' mutual obligations for developing "private social welfare programs allow eligible nonprofit organizations to create private Vocational Education and Training programs" (McClelland, 2002, p. 219). Mutual obligations are a gender issue (Klein, 2021). Therefore, mutual obligations aim to promote 'responsible citizenship' by encouraging volunteers to develop skills in VET and join the workforce (Wilson et al., 2005), for instance, by "creating more excellent volunteering as beneficial change" (Mateiu-Vescan et al., 2021, p. 1213). Thus, we will identify how nonprofit organizations with Volunteers become Registered Training Organizations. Economic and political positions lead to social partnerships. Thus, Webb et al. (2017. pp. 365-368) state that "immigrants with a warm welcome, flexibility, and cost-effectiveness in private community-based organizations and Registered Training Organizations (RTO) for competency skills as a springboard for higher employment or self-employment." Studies are inconsistent regarding immigrants accepted into VET programs that aim for life-long learning. A study in Victoria, a state with growing migration, identifies discrepancies between "immigrants accepted into VET institutions, as their prior knowledge was unequal in helping them find suitable training and employment" (Webb, 2017, p. 85). The disadvantages of VET institutions led to a lack of skills and 'marginalization' (Webb et al., 2017). Therefore, a few community-based organizations categorize migrants by language, leading to targeted immigrant support. "The choice of community-based providers to gain qualifications for low-skilled work is a strategy to finance many immigrants obtained career moves into professional work or self-employment" (Webb et al., 2019, p. 364). A study in New South Wales, an urban city with growing migration, can also identify these findings. There were issues with understanding that students may "misunderstand or fear discrimination if they speak up in classes" (Clark et al., 2018, p. 1); therefore, their research calls for cultural knowledge. Another argues that" inclusiveness practices at the community, policy and implementation levels" (Lin & Chung, 2024, p. 19) aim the need to focus on the individual to gain new knowledge (Clark et al., 2019). Another suggests that "practice well is to learn" (Hager, 2012, p. 31). Others argue that other RTOs are shifting towards cultural knowledge, and this is a gender issue (van Overbeeke et al., 2022). Others believe that volunteering and immigration can bring a new identity belonging to new settlements (Alexander et al., 2025). Others argue that unequal labour and gendered work (Lemma et al., 2024) and collaborative peer-to-peer breastfeeding support (Kåks & Målqvist, 2020; Marvin-Dowle et al., 2022; Smith, 2025). Others suggest dignity as emotional empathy (Biggs et al., 2019; Douglas et al., 2025; Gómez et al., 2021). Empathy is "socially shared experiences that may lead to and influence moral judgements as shared vulnerabilities and possibilities" (Leake, 2018, pp. 3, 7). Others state that "multicultural knowledge and relationship building will be learning empathy" (Lin & Chung, 2024, p. 19). We turn to understanding the complexity of community-based Registered Training Organizations.
Complexity: Debated
As Critical Realism seems suitable for this article, the learning-in-practice perspective of Hager (2012, pp. 30-31) states that emergence "grows out of continuous and as non-linear interactions, have properties not predictable from a knowledge of preceding structures, and where the practice is a complex web." According to Hager and Beckett (2024, p.410), small groups have learning outcomes that are "owned by the group and cannot reduce to the aggregation of the learning by individuals in the group." As Levers (2013, p. 1) argues, "grounded theory has adaptions as emergence is the core concept of complexity." The notion of complexity originates from multiple research disciplines. Moreover, this is where social sciences state, "Complexity is about relations that implicate systems and internal relations [that] can be conceptualized as a two-party system produced over time" (Lancaster, 2012, p. 121). Thus, Hager and Beckett (2024, p. 410) state that the "significance of 'emergence' is where the whole (the new knowledge and the ownership of the entire process and outcomes) is greater than the sum of its (hitherto atomized learning) parts." As Gerrit and Verweij (2013, p. 177) state in Critical Realism, "Open systems are within and about other systems." Others argue, "Critical realism aims for a non reductionist analysis of the underlying relations between learning environments, educational knowledge, and the interior world of the learner" (Kahn et al., 2012, p. 860). In this notion, the "reflective" emergence position is as an observer internal to organizational structures relative to the subjective experiences of VET adult educators. In critical Realism, human action is "embodied, institutional, or discursive structures that can be 'possessed' rather than exercised or actualized, such as positioning" (Scott, 2010, p. 5). Thus, "learning should foster the capacity to act in flexible, constructive, and innovative ways suited to the demands of ever-changing circumstances" (Hager et al., 2012, p.30).
Implications
This review aimed to determine the applicability of Critical Realism to 'provisional explanatory' information from structures that may be assumed "imperfect in their pursuit of alternative possibilities" (Scott, 2010, p. 111). Thus, the focus of educational studies. Social partnership literature adds psychological values to the notions of emergency and complexity. The ethical expertise position in Registered Training Organisations (RTO) is community-based, encompassing diverse populations (De Caro et al., 2024, p. 908). The study aimed to bring the educators of RTOs' training and work to the attention of trained volunteers working in community-based education. These studies have confirmed the educators' "moral perceptions, deliberative emotional regulations, and motivations" (De Caro et al., 2024, p. 908). Thus, as Hager and Beckett (2024, p. 418) state, "sense-making is successful transformative practices are more likely; therefore, emergence described by complexity theory is apparent, mainly make the us-ness." Community-based education supports self-help and mutual aid, including sharing experiential knowledge in self-help alternative therapy groups (Atteraya et al., 2016). Sharing knowledge is "problem-solving, as connections or emotional attachments in self-help are essential for volunteer motivation relying on 'recognition' or 'oneness' with individuals" (Cuff et al., 2016, p. 144). Furthermore, there is a need to learn as Complexity. Thus, McGrath et al. (2020, p. 572) aim to understand the "relationship between teaching and learning if the relationship is to achieve workplace competency on the part of the learner." Competency is, however, "the narrow definition and a checking off of a Checklist process rather than the holistic aspects of skill performance; thus, parts do not equal the whole" (Hager, 2019, p. 68). Thus, "Expertise is simultaneously holistic as cognitive, bodily, and affective attributes rather than discrete entities of competencies" (Hager, 2019, p. 69). The studies reviewed occur across Australia and other countries; therefore, prior experiential knowledge is essential for training in specialist volunteer practices. All trained individuals participate in "continuous professional development, which is in-house, in-state, and at international conferences" (Smith et al., 2018). Low breastfeeding rates are "gaps between high-and low-income families that have widened" over decades (Amir & Smith, 2020, p. 3). Thus, this aligns with the study findings in two cities in two Australian states (Schmied et al., 2019, p. 3). Therefore, these results indicate the need to recruit women in bicultural groups to support their communities. Furthermore, such training and the availability of accessible and willing members are needed to "mobilize and organize to sustain high levels of activism as structure and agency shape strategic choices as considering how structures change" (Han, 2015, p. 30).
The limitations of this study suggest that it is specific to Australia; however, other countries may learn from the discussion.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
