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Whatapos;s Normal, Anyway Example

Essays on What's Normal, Anyway Article What’s Normal, Anyway? The of the What’s Normal, Anyway? Mental health is extremely important for every human in the world. In this respect, there is an obvious question, namely: what is mental health? Our strong belief is that psychological health of any person is defined by his or her normal psychic reactions to different life conditions and situations, which may be even of harmful nature. In other words, mentally healthy people are constituted by psychical equilibrium that leads to the state of well-being with its capabilities of self-manifestation, self-realization and self-development. So, among the basis attributes of a mentally healthy person are a sound response, healthy behavior and desire of personal improvement, both physical and mental one. To our mind, there is the only one weak point of such a viewpoint, that is, the notion of norm as well as the concept of sound behavior is somewhat abstract or subjective, since they are determined by social norms, which can vary not only in different cases but also in minds of numerous people. Consequently, abnormality can be determined in a subjective way as well. In fact, ones there has happened a casus perceived by everybody around as odd or abnormal behavior in public. The thing is that a guy had hit a Coca-Cola dispenser with such strength that it has rocked forward and backward and has almost fallen down. Obviously, such a conduct has been seen as a manifestation of groundless aggression with further making a diagnosis of a mood disorder with its peaks and valleys. Anyway, that action has been a display of social nonconformity, for it doesn’t fit or meet social expectations of people. Only situational context gives the answer for such an act: that very Coca-Cola dispenser has taken money and hasn’t given the drink the fifth time in a week. So, there has been a particular reason, at least in the mind of that young man. Taking into consideration all the types of therapies, there i s a cognitive therapy, which most appeal to our perception, as it addresses psychological issues in a positive key of thinking, while a medical therapy is seen as least appealing, for it uses medical methods of treatment instead of putting emphasis on psychotherapy (Wadsworth, 2013). Â   To sum it up, mental health is an essential part of human wellness. It is determined by social standards and norms, so its concept can be seen in a somewhat subjective way. Anyway, analysis of behavior and appropriate treatment add to understanding of an issue and its improvement, whether it is needed. ReferencesWadsworth.(2013). Psychological Disorders. Therapies. Text modules 60 – 69.

Conflict Anarchism and Long Lasting Aftermaths Free Essays

Conflict can have tragic consequences for ordinary people In society’s composition, ordinary people establish the majority of the population creating the base of the group. When faced with challenges and conflict stemming from others in the same faction, they are affected and met with the consequences of the conflict. These effects may have tragic consequences to ordinary people with long lasting aftermaths such as portrayed in ‘Paradise Road’ and throughout history. We will write a custom essay sample on Conflict: Anarchism and Long Lasting Aftermaths or any similar topic only for you Order Now Conflict, however, comes in different forms and arrangements with varying views and purposes. This signifies that not all consequences of conflict is disastrous, and can have a valuable effect on ordinary people. The characters in ‘Paradise Road’ are essentially ordinary civilians of countries torn in war that were thrust into situations that ended with tragic consequences. From the beginning scenes the women are portrayed living luxurious but sheltered lives, following that they were plunged into the devastating prisoner’s camp showing the drastically altered life style they endured. Throughout the film the women are exposed to the unfamiliar brutality of humans, creating long lasting effects on their psychological mindset. This is seen from the ruthless death of Wing, having been caught getting medicinal tablets for Mrs Roberts. Due to the innocent and charitable nature of the act, the dreadful punishment for Wing was a surprise and vicious shock to the other women as it was nothing like their previous experiences, establishing the brutal nature of humans and course of the film. From this scene however, the idea that ‘conflict brings out the best in people’ could also be seen as Wing self-sacrificed herself. Additionally, despite the cruel conducts and treatment, the idea that ‘The survivors of conflict are true heroes’ is also brought to light as the women that were released held on til the end, surviving through will power and each other’s help and not giving into using their bodies. Evidently, although conflict can have tragic consequences on ordinary people, it can also have encouraging effects on them. Although conflict has the capacity to develop tragic consequences for average people, it additionally has positive effects on thousands of ordinary citizens around the nation. The African-American Civil Rights Movement in the United States began in 1955 due to racial prejudice and inequality, it aimed for the prohibition of discrimination and the right for African Americans to vote. The immense struggle for equal rights included many ordinary citizens throughout the nation and came in the form of nonviolent protests and marches. The confrontation lasted almost a decade and involved ordinary citizens of all nations as it sparked worldwide recognition for its aim. In 1964 the Civil Rights Act was passed allowing basic civil rights for all Americans, signifying the success of the struggle for all Americans regardless of race. This indicates that even for those not involved, the outcome affected their lives in a positive manner along with the idea that conflict not just has tragic consequences for ordinary people, but beneficial effects for them as well. Ordinary people are affected by conflict all over the world and whether the outcome is positive or negative for the particular individual, it is defined by the nature of the conflict and the possibilities it holds. Conflict does have the power to bring devastating consequences to some in many cases but there are also cases in which conflict brings about change in a positive manner with valuable and favourable effects for the individual. To define the outcome of conflict in a dichromatic way is futile as all cases will have varying components and possibilities with each action that plays on the result of the conflict. How to cite Conflict: Anarchism and Long Lasting Aftermaths, Papers

Marketing Management Business model and Infrastructure

Question: Discuss about the Marketing Management for Business model and Infrastructure. Answer: Introduction Tesla Motors is an automotive and energy storage enterprise founded in 2003. Its headquarters is based in Palo Alto, California, United States. The company was established by a team of engineers named JB Straubel, Martin Eberhard, Ian Wright, Elon Musk and Marc Tarpenning. They build this company to show to the world that cars run by electricity are much more efficient than the cars run by gasoline. The firms mission is accelerating the transition of the world to sustainable transport. This firm is involved in designing, manufacturing and marketing battery electric vehicles, battery packs made of lithium ions and components of electric vehicle powertrain. The firm has flourished from a single retail store where the vehicles are used for marketing in the year 2008 to a total of 18 stores in at least 30 countries. From 2008 onwards, the firm has sold a total of 1650 Tesla Roadsters globally with a price tag of $109,000. By the year 2013, it has a global market share of 2% in the luxury sedan segment (Motors, 2015). Teslas main goal is increasing the number of battery electric vehicles to the consumers in three different ways. First step is by selling the vehicles through its vast network of showrooms owned by the company and also through online. The second is selling the components of the electric powertrain which have patent rights to different automakers to arouse interest so that they buy more battery electric vehicles. The last one is acting as a catalyst and setting an example to the people about the importance of driving which is fun and also socially responsible to the society (Mangram, 2012, pp. 289-312). The main strategy of this firm is to initially create a market base by selling its Roadster model. After that they will launch the Model S Sedan with a base price of $57,000 and by the year 2015, they will build Tesla BlueStar at a price tag of $30,000 that could capture the middle class consumers. Product Analysis Tesla has launched some models like the Tesla Roadster, Tesla Model S and Bluestar targeting the premium consumers to the middle class consumers. An analysis of the products has been discussed below. The first one is Tesla Roadster. It comes at a price of $109,000. It is a high performance electric sports car which can drive upto 250 miles. This car uses a lithium-ion polymer battery pack. Its unique selling proposition is it takes only four seconds to accelerate from 0 to 60 mph. It has a sporty look to attract the people in the luxury sports segment that is already occupied by legendary car makers like Ferrari and Porsche (Liu et al., 2014, pp. 236-286). The next model is Tesla Model S. It is a sedan with a price of $57,000 with the aim of competing with the likes of Audi A6, Mercedes E-Class and BMW 5-Series. The car has a seating of seven people when another third row of seats with rear facing are attached. The batteries available will last between 160 miles to 300 miles. The significance of this model is it has the capacity of swapping the battery in quick time and capability of recharging with the help of power sources available in 100V, 200V and 480V. By the year 2015 they will be launching two new models namely BlueStar and Model X to cater to the middle class (Anthony, 2014, pp. 112-121). Tesla has its own manufacturing unit and it has collaborated with two major automobile firms namely Daimler and Toyota. They also partnered with an electronic manufacturing firm Panasonic and another manufacturing enterprise Lotus Cars (Pinkse et al., 2014, pp. 43-60). The luxury sedan segments and the premium sports cars evolve to be a great advantage over other brands. Their unique selling proposition includes highly efficient battery efficient vehicle technology, positioning the market as a first mover, recognition of the brand and has some unique products in their kitty like powertrains, vehicle batteries, etc. SWOT Analysis This analysis is used to describe the internal and the external environment of the company. Internal environment includes the Strengths (S) and Weaknesses (W) while the external environment includes the Opportunities (O) and Threats (T). These are explained in details. Strengths (S) A firms strengths is analyzing the resources and the capability where it can have an upper hand against other firms. Their main unique selling propositions include cutting edge technologies related to various equipments like design of the vehicles, battery and powertrain technology. They have highly efficient products like range of the electric batteries which lasts upto 300 miles with one time charging and eye-catching designs of the vehicles like the Model S. Their management is open to new ideas and flexible in their working style and their leaders have an innovative thinking approach. They have positioned themselves as a first mover in the battery electric car market. They have built a superb reputation among the consumers through word of mouth and also the media have positive reviews about the company. The business model and their logistics network which is very innovative help them to have a competitive advantage over the others (De Pin, 2015, pp. 163-185). Weaknesses (W) Their structure that is business model and also the infrastructure is very costly due to absence of major economies of scale. As the electric vehicle industry is a new entrant so time and trust is required to be built to get a strong foothold in the automobile industry. Their recognition of the brand name is very limited as there are various brand names prevailing in the market and the big brand names have a strong legacy. The supplies for the components of electric vehicle are limited and it would create a problem if there is a rise in demand. There could be problems in the producing the output as Tesla manufacture their products with the help of Lotus Cars whose capacity of producing is very limited. So when there will be a high demand in the luxury sedan market they can face problems. Another problem with Tesla is they have very less number of stations for charging the vehicles, the mile range that is upto 300 miles, various types of charging options (Birk, 2015, pp. 20-25). Opportunities (O) There are some opportunities for Tesla Motors that are a boon to them which are described below. There are major advancements in the vehicle technology and that is good news for Tesla. By owning a battery electric vehicle, consumers could understand the benefits related to cost and environment. Due to increase in prices of gasoline, the producers and also consumers are looking for alternative power sources. Peak-oil pressures globally led to searching for other options. Various policies drafted by the government for infrastructures are required for adopting battery electric vehicles. Due to rising tension about the global warming and various pollutions in the environment led to the entry of the electric cars in the market. High chaos created to reduce to dependency of fossil fuels and security of energy helps Tesla to get a strong foothold in the market. Increasing number of mandates and the regulations by the government for adopting battery electric vehicles like providing subsidies to the electric vehicle, subsidizing those who are phasing out of the fossil-fuels, etc (Truong et al., 2016, pp. 14). Globally the governments are providing incentives like rebates, tax-breaks, loans with low interest rates and various grants for adopting the battery electric vehicles. Many sectors like the premium sports cars and the luxury sedan segments are still not touched by many brands and these areas can be of huge potential for Tesla (Nykvist Nilsson, 2015, pp. 329-332). Threats (T) There are some threats that need to be countered to sustain in the market. There is rise in various firms who are also selling BEV directly to the consumers. Rising of substitutes against BEVs like the plug-in hybrids, hybrids powered through gasoline, vehicles running with natural gas, ethanol powered vehicles and non-electric vehicles which are more fuel efficient than the electric vehicles. The entry of the big automobile firms in the BEV segment which have capability of higher economies of scale. Superior and efficient cutting edge technologies used in the BEV as compared to the technologies used by Tesla. Alternative sources of energy like vehicles run with hydrogen are creating a barrier for Teslas rise in the BEV segment. Decrease in the oil prices for a short period could hinder Teslas growth and people can use cars run by gasoline (Barmore, 2013, pp. 185). Strategic Marketing Plan of Tesla Their major marketing goals include generating demand for the vehicles by generating leads with the help of their sales personnel. Next is creating a long and lasting awareness about their brand in the minds of the consumers and have a good reputation in the corporate arena. Managing the existing customers so that they can be turned into loyal customers and create a strong market base with the help of the customers referring to others about their brand. Getting customer feedback is very important so that they can create more efficient product that can satisfy customers needs (Moritz et al., 2015, pp. 85-92). BCG Matrix for market growth rate: Star Market growth rate is extremely high as company has already able to expand in different geographical areas successfully Highly effective market penetration strategy implemented by Tesla Motors Question mark Limited consumer base for Tesla Motors due to high price Lack of well-developed infrastructure in the Australian market such as dealerships, factories, supply limitations Cash cows Tesla Motors have huge share of the market particularly in USA and some of the European countries but it had very low growth rate As a result, the company has to investment huge amount to ensure its growth in the new market Dogs Comparatively low market share in the Australian market. As a result, business units of Tesla Motors has face cost disadvantage Figure 1: BCG Matrix (Source: Contreras 2015) Marketing Strategy The firm has adopted the marketing strategy of Apple for cutting edge technologies. It started with the thought that any new technology that will be launched in the market is costly and the millionaire people will be the first customers to use the new technology. So, Tesla launched the model Roadster targeting the rich consumers in the premium sports car segment for the optimization of the technology before launching affordable cars to the mass consumers. Brand/Product Positioning The companys image and the positioning of their products for its battery electric vehicles emphasizes the features of the cars like using innovative technologies, reliability, attractive in terms of design and it is eco-friendly with zero emission of carbon dioxide (Birk, 2015, pp. 125). Market segmentation A firm can solve the consumers needs by segregating the vast heterogeneous market into small segments which can be easily manageable. Tesla has identified three different segments for adoption of their products. First is the market for the premium sports car. This is a small market which many people dont know about Tesla brand so this area can be targeted to sell the products. Next is the luxury vehicle sedan market. This is a large market where the competition among other reputed brands is very high. This is an area where there will be lots of customers to buy the BEVs. The last one is the mainstream vehicle market for the consumers. Here they will create affordable cars to target the mass consumers and can create a strong foothold in the market (Gomes, 2013, pp. 141-151). Product design strategy This strategy is related to the looks, feeling and the functioning of the product according to the demands of the consumers. Designing of the product enables to differentiate and helps in positioning of the product compared to other brands. Their major objective is the Model S that will create a sedan of middle size that can accommodate seven people with luggage and the car will be eco-friendly, various functions that suits customers needs and sporty look. The car boasts of zero-emission standard. It has a highly decorated interior with a touch screen of 17 inch and a control centre which is known as the iPhone of the auto industry. It has a battery with life expectancy upto seven years and it ranges from 160 miles to 300 miles (Rimmer, 2014, pp. 525-656). Product pricing strategy As the firm is a premium brand and uses innovative technologies that are costly. So they rolled out the high-end model named Tesla Roadster at a cost of $109,000. This master strategy is used to accommodate the unit costs which are high and also the cost of unit volume is low for a marketing model that is using cutting edge technology. Their main target is to sell the BEVs at a cheap price within the price range of $30,000 to $57,000 so that they can penetrate more into the auto market (Martins et al., 2015, pp. 99-117). Branding strategy They have already built a strong brand foundation by introducing the Tesla Roadster model. Model S which comes at a cost of $57,000 will attract large consumers which will help to increase the sales volume. The Model S design highlights a BEV brand which can be driven by both male and female, has advanced features with cutting edge technologies. The car can be used by everyone with superb safety features which makes it lovable for environment conscious consumers. The company has able to create the brand through the power of word-of mouth and through corporate events. The firm is creating a technological hub for building products, which are innovative like Model S and Roadster, and also various products like battery packs, components of powertrain, technology related to managing power supply and extra lines of BEV (Hardman et al., 2015, pp. 1625-1638). Product life cycle curve of Tesla Motors: In the Introduction stage, Tesla Motors will have to focus about the market penetration strategy so that it can able to connect with the major portion of the customer. Since, Australia as a market has huge amount of potential to increase the present level of revenue for the company. Tesla Motor has to spend huge amount of money on its marketing campaign. In the growth period, Tesla Motors will have to focus on the knowledge level of the potential customer. Since, it will help the company to gain different portion of the market. As mentioned earlier, Australian market has huge potential, which can help Tesla Motors to increase its present level of revenue. Maturity stage involves Tesla Motors to initiate innovative strategies, which can prolong the lifetime of newly introduced product of the company. For instance, Tesla has to initiate product trial for the customer to increase their present level of satisfaction. The company also will have to secure its retail distribution so that it can avoid the decline stage of product life cycle for a longer time. Figure 2: PLC of Tesla Motors (Source: Gomes 2013) Sales and Service strategy Tesla doesnt have any franchises to sell their products. They sell their cars and market them directly to the customers with the help of stores owned by the firm all over the world, through telecalling or meeting the person at their headquarters or through corporate events. Tesla has opened their stores which have a higher visibility, premium outlets in the main metropolitan areas which are a trend setter for the public (Crane, 2015, pp. 652). The stores opened by the firm act as showrooms are designed in such a way that the customers get to know about the benefits of owning a electric vehicle and the specific beneficiaries of having a Tesla car. The stores are equipped with snack which are provided free of cost, coffee bars, couches which are very comfortable and fast internet connectivity. The Tesla customers engage directly with highly skilled Tesla employed sales and service personnel which are quite different from the buying experience when the customers enter into a traditional vehicle franchise outlets and their service centers. In the future they will introduce Mobile service vans for servicing the Tesla vehicles situated in the remote locations (Reinecke, 2014, pp. 84-88). Marketing Communications plan The plan should be crafted for educating the sales prospects about the advantages of owning a Tesla car as compared to other electric, hybrid or gasoline powered cars. They should inspire the prospects to visit their stores to get a firsthand experience about the products. Tesla should interact with firms customers, sales personnel of their retail outlets, industry analysts and the media addressing the different needs of each of the groups in a transparent way. This helps them to eradicate further talks with any third party or any dealer outside their network (Abdulsater et al., 2014, pp. 215-238). Advertising Strategy The firm should give importance to the special events and the conferences that are at par with Apples MacWorld Expo and the Apple Expo. These types of events attract a lot of sales prospects and the media people. They should launch campaigns which should contain creative themes like Drive Different that would attract creative and innovative customers for engaging (Hirsch Hirsch, 2016, pp. 52-56). They can be successful by introducing a series of BEVs with the help of media outreach and reviews, explaining the importance of electric vehicle technology and reinforcing their product line with the help of the models like Roadster and Model S. They have positioned themselves as the first firm to commercially manufacture an all-electric car that complies with the federal laws and is successful in becoming a market leading range with a single charge. Due to extensive media outreach globally and through word-of-mouth they have able to scale higher without any specific advertising plan and their marketing costs are very less. Another strategy would be highlight the members of the Tesla design team in main media outlets which focuses on green technology, automobile freaks, automobile technology, etc. (Contreras, 2015, pp. 787). Sales promotion strategies Tesla has showcased their products in Frankfurt, Los Angeles and Detroit auto shows. They should create specialist events once in a year and several conferences which should be on the same page like the Apples Mac World Expo and the Apple Expo. The firm should have a partnership with top notch car magazines like Car and Driver or Motor Trend for supporting the publication of Teslas specialty magazine focused on the electric vehicle industry like TeslaWorld or EVWorld. By collaborating with the major green, clean energy non-profit organizations for promoting the advantages of BEVs. They should join various programs initiated by the government for promoting to adopt the electric vehicles and provide different incentives for purchasing electric vehicles (Yeleti Sayed, 2015, pp. 56-69). Budget allocation Marketing technique Investment amount Expected income Search engine marketing and website and marketing $15 $22 Direct marketing $10 $18 Event marketing $5 $22 Social media marketing $25 $17 Display marketing $17 $12 Video marketing $23 $10 Electronics marketing $25 $26 Table 1: Budget allocation (Source: Contreras 2015) Recommendations The company must continue to build innovative products and also launch various cars with creative designs. The firms electric vehicles of innovative technologies, battery technology and components of powertrain for electric vehicles have created a strong foundation for Tesla. They should build few and memorable products which should be of highest quality as compared to other auto makers. Ads created should be very unique, focusing on high quality and should be effective for creating a stimulating effect in the minds of the consumer. Tesla should create a theme like Drive Different for showcasing to the world about their eco friendly and sporty look cars. To create a good public relation they should place their products in motion pictures and television shows. The enterprise should launch their products in high profile events by discussing about the cutting edge technologies and eco-friendly BEVs (Thomopoulos Givoni, 2015, pp. 1-14). Conclusion Due to rise in oil prices, global warming, various types of environmental pollution and environment conscious consumers, battery electric vehicles are set to rule the automobile industry (Bohnsack et al., 2014, pp. 223-232). Many brands which have a rich legacy in the automobile industry have started to position themselves by launching various BEVs which have a larger market share than Tesla and have various advantages related to prices, production and marketing. So Tesla should focus on having a good brand recognition, the cost structure should be optimized and should built a robust infrastructure where there will be more company owned stores and more charging stations. They should create more technology hubs for catering various product lines. The firms mission is accelerating the transition of the world to sustainable transport and it can be concluded that they are moving in the right direction. References Abdulsater, A., Balasubramanian, A., Wang, B., Madani, F., Mansour, M., Talla, R. (2014). Technology Road Map for Tesla Motors Sedan EV. In Planning and Roadmapping Technological Innovations (pp. 215-238). Springer International Publishing. Anthony, S. (2014). Tesla unveils dual-motor autopilot Model S. New P85D has 691 hp, 0-60 mph in 3.2 s., 21(2), 112-121. Barmore, C. (2013). Tesla Unplugged: Automobile Franchise Laws and the Threat to the Electric Vehicle Market. Va. JL Tech., 18, pp. 185. Birk, D. (2015). Evaluation of the Marketing Strategy of Tesla Motors Inc., pp. 20-25 Birk, D. (2015). Tesla Motors, Inc. Market Analysis and Definition., pp. 125 Bohnsack, R., Pinkse, J., Kolk, A. (2014). Business models for sustainable technologies, pp. 223-232 Contreras, J. L. (2015). Patent Pledges: Between the Public Domain and Market Exclusivity. Michigan State Law Review, 2015(2), pp. 787. Crane, D. A. (2015). Tesla, Dealer Franchise Laws, and the Politics of Crony Capitalism. Iowa Law Review, Forthcoming, 2015(3), pp. 652. De Pin, F. (2015). How Tesla integrates Shared Value principles with Ecosystem Innovation to build sustainable competitive advantage, 42(3), pp. 163-185. Exploring business model evolution in the case of electric vehicles. Research Policy, 43(2), pp. 284-300. Gomes, L. V. (2013). The case of BMW Group and Tesla Motors: mergers and acquisitions (Doctoral dissertation), 2(1), pp. 145-151. Hardman, S., Shiu, E., Steinberger-Wilckens, R. (2015). Changing the fate of Fuel Cell Vehicles: Can lessons be learnt from Tesla Motors?. International Journal of Hydrogen Energy, 40(4), pp.1625-1638. Hirsch, P. B., Hirsch, P. B. (2016). The flashing of fireflies. Journal of Business Strategy, 37(3), pp. 52-56. Liu, Y. E., Kang, Y., Wu, H., Chen, C., Hon, E. (2014). Tesla Motors Inc. Case Synopsis, 26(4), pp. 263-286. Mangram, M. E. (2012). The globalization of Tesla Motors: a strategic marketing plan analysis. Journal of Strategic Marketing, 20(4), pp. 289-312. Martins, L. L., Rindova, V. P., Greenbaum, B. E. (2015). Unlocking the hidden value of concepts: a cognitive approach to business model innovation. Strategic Entrepreneurship Journal, 9(1), pp. 99-117. Motors, T. (2015). Powerwall; Tesla Home Battery'.URL: https://www. teslamotors. com/powerwall (accessed: May 2, 2015). Moritz, M., Redlich, T., Krenz, P., Buxbaum-Conradi, S., Wulfsberg, J. P. (2015, August). Tesla Motors, Inc.: Pioneer towards a new strategic approach in the automobile industry along the open source movement?. In Management of Engineering and Technology (PICMET), 2015 Portland International Conference on (62(3), pp. 85-92). IEEE. Nykvist, B., Nilsson, M. (2015). Rapidly falling costs of battery packs for electric vehicles. Nature Climate Change, 5(4), pp. 329-332. Pinkse, J., Bohnsack, R., Kolk, A. (2014). The Role of Public and Private Protection in Disruptive Innovation: The Automotive Industry and the Emergence of Lowà ¢Ã¢â€š ¬Ã‚ Emission Vehicles. Journal of Product Innovation Management, 31(1), pp. 43-60. Reinecke, S. (2014). On the Way to Sustainable Transportation. Marketing Review St. Gallen, 31(5), pp. 84-88. Rimmer, M. (2014). Tesla Motors: Intellectual Property, Open Innovation, and the Carbon Crisis. The Australian National University College of Law, Canberra, 36(4), pp. 525-656. Thomopoulos, N., Givoni, M. (2015). The autonomous cara blessing or a curse for the future of low carbon mobility? An exploration of likely vs. desirable outcomes. European Journal of Futures Research, 3(1), pp. 1-14. Truong, C. N., Naumann, M., Karl, R. C., Mller, M., Jossen, A., Hesse, H. C. (2016). Economics of Residential Photovoltaic Battery Systems in Germany: The Case of Teslas Powerwall. Batteries, 2(2), pp. 14. Yeleti, B. M., Sayed, H. (2015). BRANDS BRANDING; GROUP 15. Month, 45(5), pp. 56-69.

Bill M. Beverly Essays - Dating, Interpersonal Relationships

Bill M. Beverly English 099-LS1 Essay #1 March 3, 2017 What a date When it comes to dating, some people have forgotten what the actual definition means. The idea of d ating has not been around as long as people might think and it can be misunderstood . There are three types of dating that one can be involved with : intimate encounters , online dating , and courting . D ating can be a very complex activity, considering different personalities and goals . When speaking of i ntimate encounters , there generally is not a lot of commitment. S ome people treat this type of dating like escorting but without being paid for services rendered. This type of rendezvous has no strings attached , which usually include just one - time encounters , but could lead to more depending on the connection made . Prostitution could even be defined as this type of encounter when the services rendered are paid. People dat e just for fun without committing in any way with the other p arty . People also date on their mobile phones by s exting , which is texting each other explicit pictures and intimate messages. Another type of mobile phone dating uses the applications of Facetime or Skype. These options use video calls where the other party is visibly live in real-time on the other end of the line. Flings also use these means of communication by people to have relationships whether sexual interac tion is to be included or not. Sometimes, it is not always about the sex but more about just having a fun night out , which people need every once in a great while. Online dating has been a successful means of connecting with others. Websites like E - H armony , which is the so-called #1 trusted online dating site , is used by all ages of men and women. This website has been the most successful per reviews from the website and users alike for connecting people with like personalities and traits . A person undergoes a very detailed application process to have a profile activated on the website. This allows the user to search and find their match , which c ould lead to either marriage or soul mate. T inder , is another online website that can be used as an online rendezvous /no strings attached method of connection . There are some precautions to take heed with when dating online. For example, the transfer of sextually transmitted diseases, where contraceptive measures are not utilized or p regnancy even if a contraceptive is to be us ed , being that it is only 99% effective. Lastly, the website Match.com , which is the leading online dating site for relationships , is typically used by older people. With the same features as E-Harmony, Match.com claims that is has the same features. People can have a lot of success while dating online but sometimes relationships do not work out. Courting is the oldest , most traditional form of dating. Dating in this way is the more proper and practical approach. There is one on one with no family interaction at the start. Flowers being brought to the first date is usually a sign of respect towards the other party. People can use this version of dating if they will be seeking out a long-term relationship with someone. This also brings into question the idea of consummation. Consummation is defined as having sexual intercourse to make marriage or a romantic relationship complete. When courting is involved, the parties will respectfully spend time with the potential spouse's family . T his is depending on how far into a relationship the parties are planning to go. After courting, an engagement is usually the next step , preceded by the purchas e of a ring for proposal. Another factor brought into the relationship is the determination of God's will for them to be married. If this is the case, the eng aged couple will possibly wait until the wedding night to consummate the relationship making it complete and faithful. D ating can be a very complex life choice , w ith regards to different people and their personalities

The Program on Smoking Cessation for Employees

The Program on Smoking Cessation for Employees Introduction There are a number of programs on smoking cessation design for employees that are premised on various data analysis techniques. Despite the diversity of data collection methods, all the programs are aimed at improving employees’ lifestyles and creating new incentives for increasing employees’ productivity and performance.Advertising We will write a custom essay sample on The Program on Smoking Cessation for Employees specifically for you for only $16.05 $11/page Learn More Moreover, there is a growing trend in evaluating the practices and improving the strategies on creating a program. The systematic evaluation can allow managers to solve problems and help community-based organizations to improve the quality of services and working conditions. Despite the veritable understanding of evaluation of program evaluation, there is a need for creating a comprehensive framework. Therefore, analysis of other frameworks for programs on smokin g cessation will help to integrate successful data collection and analysis methods that can contribute to the quality of program outcomes. The evaluation process implies investigating worth, significance, and merits of efforts made during the program implementation. Invention of new methods and approaches has been developed to embrace the multiple aspects of the program, define its strengths and weaknesses, and outline significance and main elements of the data collection process. All these procedures will provide a better understanding of how the program can be improved and modified to reach greater objectives and goals. Finally, the evaluation process has great importance for governmental organizations that assess the usefulness and validity of the programs for future implementation in other settings. The program under analysis focuses on a smoking cessation opportunity for employees. It involved 70 participants who plan to quit smoking; 11 participants managed to quit smoking, wh ich pointed to the success of the program and its future potential.Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Certainly, though the ratio of the participants who had quit smoking was not significant, there were still methods and alternative researches that could help understand how to improve this program and increase the number of employees who were ready to give up smoking. Main Discussion Integrating Data Collection Methods into the Program Evaluation Plan With regard to the above-presented background, the program involved only 70 participants and it was based on a local hospital in Ohio. The success of the program is evident because it was primarily based on observation process, as well as on the results of employees’ interviewing in a natural setting. Nevertheless, the framework within which the program was implemented did not allow the researchers to create great e ffect on the participants. In this respect, it is purposeful to assess related programs on smoking cessation to define which methods could be integrated into data collection methods. The studies by Shershneva et al. (2011) have introduced a spectrum of approaches and methods that allowed the researchers to reach over 43,000 clinicians (p. 29). What is more important is that the program involved collation of comparison data among different program components to define the degree of its effectiveness. Such an approach could be applied to define how employees of Ohio hospital can enhance their incentives to take part in programs and increase number of those who are ready to quit smoking. In addition, the assessment of employees performance through implementation of 4 levels of evaluation, including participation, satisfaction, learning, and performance also contributes to better outcomes through engagement of the 5 A’s algorithm. Specifically, the algorithm involves, â€Å"Ask about tobacco use, advise to quit, Assess readiness to quit, Assist with cognitive/behavioral strategies, assist with medication, Assist with relapse prevention, and Arrange for follow up† (Shershneva et al., 2011, p. 29).Advertising We will write a custom essay sample on The Program on Smoking Cessation for Employees specifically for you for only $16.05 $11/page Learn More Such an extensive overview of aspects and factors influencing employees’ behavior and perception would allow Ohio hospital program to expand its techniques and improve the quality of goals achievement. In order to accomplish the program purpose and establish a multi-strategic approach to change, implementing knowledge management and skills enhancement is crucial. Skills and experiences are vital to reach the objectives in the most effective way, as well as increase the usefulness of the training program. In this respect, Labib et al. (2012) have conducted an evaluation of th e training program to define how background knowledge and skills influence the outcomes (p. 52). Similar to Shershneva et al. (2011), the scholars have employed the 5 A’s algorithm for implementing the program objectives (p. 30). These studies have significant implications for integrating medical education in smoking cessation programs. Training healthcare personnel, therefore, is an essential condition for increasing employees’ awareness of the negative effects of smoking. The data collection methods implemented by Volpp et al. (2009) are premised on randomized sampling of employees working for a multinational company to gain data about programs on smoking cessation, as well as on the effectiveness of these programs in terms of financial incentives (p. 699). Analyzing and selecting the participants gathered across the United States was carried out through surveys that encouraged the employees to give information about their smoking habits and their willingness to part icipate in the program. In contrast to these approaches, the Ohio program on smoking cessation did not involve financial incentives for employees; rather it aimed to check for employees’ awareness of the necessity to quit smoking that is not linked to financial rewards. Nevertheless, implementing surveys could also be beneficial for the program accomplishment.Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Strengths and Weaknesses of Data Collection Sources Assessment the strengths and weaknesses of the data collection sources creates a new insight into possible methods and approaches to conducting programs and developing efficient plans for health promotion. Due to the fact that the main purpose of the program on smoking cessation consisted in improving healthy lifestyles of their employees, the focus on cost reduction and insurance seems to be irrelevant. In order to define the potential strengths and weakness of the program, specific emphasis should be placed on the target participants involved into data analysis, the framework for interpreting data, which method is the safest for collecting data and information processing, and understanding the appropriate value of those who provide information. In addition, the methods for data collection should also be discussed in terms of their influence on the target populations. Finally, the availability of resources for collecting informati on should also be considered, including financial perspective, personnel, and level of skills and experiences. The research studies presented by Volpp et al. (2009) also reveal beneficial approaches to data collection methods that could be employed into the program at issue (p. 700). In particular, the scholars apply to the stratification process of employees in accordance with place of work, level of smoking dependence, and income. Such an approach has not been implemented into the program at Ohio hospital, although it could have provided a better picture of results and findings and that of the level of employees’ readiness to quit smoking. However, the program has the stratification of employees in accordance with age, which provides the strong side of the programs in terms of its applicability to the employees regardless of age. The main strength of the program lies in the availability of the cost-benefit analysis of its outcomes. In particular, the Ohio program on smoking cessation ensures that the more employees are invited into the program, the more moneys will be saved through the insurance cost reduction. What is more important is that the program seeks to increase employees’ productivity through considering financial incentives. Contrary to the benefits of the studies conducted by Volpp et al. (2009), there is strong necessity to introduce alternative programs that do not imply money as the main incentive for successful outcomes (p. 701). Hence, presence of financial incentive is the tangible weakness of the program because there should be other effective ways for raising employees’ awareness and reducing their dependence on smoking. In particular, Labib et al. (2012) argue that focus on training of health care professionals has a positive impact on improved smoking cessation outcomes because it encourages employees’ readiness to participate in the programs and improve the overall quality of services (p. 53). Knowledge dist ribution, therefore, is considered to be vital for triggering cessation interventions. According to Labib et al. (2012), â€Å"one of the major barriers in starting a smoking cession campaign or practice is that many health professionals do not have the skills and knowledge of how to intervene† (p. 56). In this respect, the program could have been premised on other incentives than monetary support. Another weakness of the program lies in insufficient number of employees taking part in the program. The sample does not provide perspectives for utilizing this program in future development of health care environment. Limited number of participants contributes to the selection biases. Similar problems are provided in the studies by Labib et al. (2012) that have confirmed the restriction imposed on the program implementation (p. 57). The value of appropriate sample, however, is presented in the program evaluations provided by Shershneva et al. (2012, p. 31) and Volpp et al. (2009, p. 700) who offered a much greater sample. Threats to the Data Collection Process While implementing a qualitative approach to the data collection process, there might be data biases related to the nature of observation of participants in natural environments, as well as to the depth and objectivity of conducted interviews. For example, such aspects as gender, language patterns, age, and ethnicity can affect the data analysis due to the focus of the study. Data collector bias is connected with the unconscious information distortion while collecting data. For instance, the interviewers can resort to different styles in posing questions to the respondents and such a bias is a decisive factor in case interviewing is the primary source for analysis. With regard to the program, the researchers have introduced age characteristics only and failed to consider other aspects of data collection process. Despite the fact that it does not influence greatly the program outcomes, it can negatively contribute to the accuracy and internal validity of the research. Apart from threats to internal validity, there are also hazards to the external validity as well. This is of particular concern to the selection effects that can either be delineated or replicated. Setting effects are also taken into consideration while estimating the employees’ influence on the surrounding setting and vice versa. Due to the cultural and social diversity, the outcomes of the program can also be different. Finally, the employees might perceive the scope of the program differently due to a multi-strategic approach chosen to conduct a program. As a result, some terms and definitions can be understood in a different way. Similar concerns are connected to the employees’ perception of the explanation provided by the researchers. For instance, some of participants might think that the main incentive of smoking cessation is insurance reduction rather than improvement of the health care environm ent. In fact, the reduced costs constitute only the cause of the program purposes. Data Analysis Procedures Due to the fact that the program is primarily based on the statistical evaluation of the results, the data analysis procedures should involve review of related programs on smoking cessation – a qualitative approach to estimating the practical significance of the data. This type of inductive qualitative analysis will provide a wider explanation for the program value in terms of employees’ behavior and other qualitative characteristics. In particular, the literature surveys will guide the researchers through different data analysis approaches that have been used in related programs on smoking cessation. Depending on methodology and research design, the literature review can also assist researchers in developing an efficient framework for data processing. Quantitative analysis is also essential for estimating the cost-benefit analysis of the program, as it is presen ted in the case. In this respect, the program focuses on the statistic evaluation of the age of participants who plan to quit smoking. With regard to the presented case, the chosen data analysis procedures should involve a mixed method of evaluation to insurance that both observations and statistical data, including age, gender, and other attributes, have been carefully considered. Such a decision is enhanced by the evidence received from related studies on smoking cessation programs. In particular, although not all research studies resort to the analysis of literature reviews, all of them apply to statistical analysis of the received data (Volpp et al., 2009, p. 700; Labib et al., 2012, p. 56; Shershneva et al., 2011, p. 32). Specific attention requires the studies by Chan and Heaney (1997), in which the focus is on quantitative research (p. 352). In fact, statistics allows the scholars to define which of the mentioned characteristics are the most important for the program outcome (Boulmetis Dutwin, 2005, p. 123). Qualitative aspects are revealed through presenting the conceptual framework under which various notions and definitions are presented. The conceptual framework is of high important for the program under evaluation as well, because it will allow the research to provide a detailed objective explanation of the research goals, procedures, and definitions to the participants. Practical and Statistical Significance of Data The importance of incentives included into the program implementation process is important both for the researchers and for the focus group (Posavac, 2010, p. 15). In this respect, the studies by Volpp et al. (2009) proves that the presence of financial incentives can significantly foster the employees’ engagement into the program accomplishment as compared to those participants who are triggered only by the awareness of the potential benefits of smoking cessation (p. 705). Within the context of this research, it can be stated that the program under analysis could have integrated this aspect to promote greater results. Statistical significance of the data involved into the process demonstrates how numerical data allows the program managers to conclude how the project influences employees’ awareness of smoking cessation initiative. Essential Elements of Program Evaluation Report A Program Evaluation Report should be based on the analysis of five important components that include philosophy and goals, needs assessment (analysis of the participants), program planning procedures, implementation, and the evaluation itself (Boulmetis Dutwin, 2005, p. 156). To begin with, the program has clearly stated its goals and objectives that are confined to creating incentives for employees to quit smoking, promoting healthy lifestyles, and developing a multi-strategic approach to change. Reduction of insurance costs is another important outcome of the program on smoking cessation. Needs assessment focuses on the target audience involved into the program. In this respect, the case shows that the participants are not limited to age, gender, and ethnicity, which imposes certain biases on the results. As per program planning procedures, the case study does not provide sufficient explanation for the stages of employees’ participation. Instead, it refers to the outcomes and benefits of the program accomplishment. The program implementation focus has sufficient presentation. In addition, the program outcomes have proved that its goals and objectives directly relate to the expected results. Finally, the evaluation process itself has managed to address such important issues, as data collection methods and all possible biases related to them. Such an assessment allows the program managers to predict possible threats and risks in future. Research Utilization Processes The results of the program demonstrate that employees’ engagement into the evaluation process creates cost benefits for t he hospital, irrespective of the number of employees who quit smoking. Irrespective of age of individuals who quit, the program is worth utilizing for future practices. Despite the win-win situation, the program could be advanced to provide potential benefits for employees’ welfare and future promotion of healthy lifestyles. Hence, the program both benefits the hospital and the employees. Despite the fact that the hospital employing the participants was the focus of the program, it still has a positive effect on the employees’ physical and mental health. In this respect, the utilization processes could be used for two major purposes – to develop alternative incentives for employees to quit smoking and introduce cost benefits for the hospital. Such perspectives of the utilization processes can convince stakeholders to employ the program in their settings. Conclusion The analysis of the program on smoking cessation held at Ohio hospital has outlined to major advan tages – development of incentives for employees to promote healthy lifestyles and improve their performance, as well as reduction of insurance costs that the hospital should cover for sustaining employees’ health. The program has also been evaluated concerning the data collection methods, strengths and weakness of data analysis, potential threats to implementing data collection resources, and possible utilization processes that can be used to guide practices in health care. All these aspects have revealed advantages and disadvantages of the program. In particular, the analysis of literature related to the program has provided the necessity to select a mixed method for estimating the participants and the outcomes. Involvement of qualitative and quantitative data is indispensible for enhancing practical and statistical significance of the data. The main weakness of the program lies in irrelevant approach chosen for selecting the population sample. References Boulmetis, J ., Dutwin, P. (2005). The ABCs of Evaluation: Timeless Techniques for Program and Project Managers. US: John Wiley and Sons. Chan, W., Heaney, C. A. (1997). Employee Stress Levels and the Intention to Participate in a Worksite Smoking Cessation Program. Journal of Behavioral Medicine, 20(4), 351-364. Labib, N., Radwan, G., Salama, R., Horeesh, N. (2012). Evaluation of Knowledge Change of Internal Medicine Residents Following a Training Program in Smoking Cessation. Pakistan Journal of Medical Research, 51(2), 52-58. Posavac, E. J. (2010). Program Evaluation: Methods and Case Studies. US: Pearson. Shershneva, M., Larrison, C., Robertson, S., and Speight, M. (2011). Evaluation of a collaborative program on smoking cessation: Translating outcomes framework into practice. Journal of Continuing Education in the Health Professions, 31, 28-36. Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., Audrain-McGovern, J. (2009). A Randomized, Controlled Trial of F inancial Incentives for Smoking Cessation. New England Journal of Medicine, 360(7), 699-709.

Comparison between Manual Gear and Automatic Gear Research Paper

Comparison between Manual Gear and Automatic Gear - Research Paper Example Such a transmission is made up of a series of gears that are used to produce the rotational force needed to turn the wheels of the vehicle. The transmission unit of a car which is commonly called a gear box has gears which transfer power form the engine of the car to its wheels. The transmission has to be equipped with multiple gears in that the car operates on the proper gear in different situations. The gearboxes are of multiple types with the difference being the determinant factor of how a car will operate. There are two main types of gears; manual gear and automatic gears. Modern cars have been equipped with two major transmission options, namely; manual or automatic transmission. There exist a number of differences between these transmission types with regards to their components, how they operate, the advantages and disadvantages associated with them and their applications. This paper is going to look at the differences evident between automatic transmission and manual transmission. A manual gearbox type is a car transmission which permits the driver to choose gears as he or she wishes with the use of a stick shift. For the driver to select the desired gear, the clutch pedal has to be depressed making it unique to cars with manual transmission (Zheng W. Chung et al 2007). This move disengages the gearbox disconnecting it from the engine. Once the desired gear has been chosen through having the shifter moved to the correct position, the clutch is now free and can be released. This action reconnects the gearbox and the engine. Manual transmission can be classified into two types; the constant-mesh type and the sliding-gear design. In the sliding gear design, its main parts are the cluster and drive gear. On each gear is a dog clutch fitted with a hub, a shaft and an outer ring (Zheng W. Chung et al 2007). Synchronizers are also fitted to prevent clashing of the gears. The hub mainly splines the drive gears while

Experience of an International Student Essay Example | Topics and Well Written Essays - 750 words

Experience of an International Student - Essay Example Older people are notably more well respected that the younger ones. Contradicting the opinions of older people is considered as a taboo in my native country. In other words, if your ideas tend to undermine the ideas of the person who is older than you are, you better keep your ideas to yourself if you don't want to offend the sensibilities of the older person. While growing up in Asian household, I deal with adult members of the family most of the time. My close associate with adults led me to become more humble and modest as our culture demands for it. Because of the strong influence of my elders in shaping my character, I tend to behave just as modestly as I would around older people when I am with my peers. Unfortunately, my modesty often leads my peers to underestimate me. This situation is really frustrating for me. While in America, I try to see things more differently. I want to broaden my horizon and embrace the freedom of expression. I am confident that having a broader pers pective of things will open up wider latitude for me to realize my dreams. Yes, I lot of people from my native land may not really understand my need to be free from the bounds of culture and practices but I feel that being able to express my true self is very important. I believe that creativity is one of the best ways to express ones uniqueness. Creativity has always fascinated me as one of the most important human characteristics. Unfortunately, I think creativity is at odds with modesty.

Unfair Treatment of Minorities in the Criminal Justice System Essay

Unfair Treatment of Minorities in the Criminal Justice System - Essay Example Unfair Treatment of Minorities in the Criminal Justice System The U.S. criminal justice system has come under critical public scrutiny in the recent years for one of the age-old problems afflicting the nation - racial discrimination. The present research attempts a review of criminal justice administration in the U.S. with a view to establishing the thesis that minorities, Blacks and Latinos, are discriminated against at every stage within the criminal justice system - the racial minorities are charged with more serious crimes, have less opportunity to plea-bargain, are convicted more frequently, and receive harsher sentences when compared with Caucasians in similar situations. The scope of the research is limited to the extent of establishing the thesis and shall not attempt to analyze the underlying causes and/or examine the possible strategies for ensuring equal justice to all. It is significant to note that the issue of unfair treatment of minorities has been a subject of research and academic interest by mainly social science researchers and lawyers. While researchers tend to disagree on the sources of disparity or overrepresentation of minorities, as to whether it is due to disproportionate involvement in criminal offenses or to criminal justice system biases, there is a general consensus that minorities are disproportionately represented and are treated unfairly at almost every stage of the justice system. [Kramer and Steffensmeir, 1993; Blumstein, 1993; Cole, 1999] A review of the available research is attempted to understand how researchers have approached and addressed the issue. According to Coramae Mann, racial discrimination is endemic to the United States; it permeates the criminal justice system and all other American institutions, resulting in the unjust treatment of racial minorities. She claims that when the "more flagrant, systemic means of economic and political control of minorities used in the past were no longer feasible or morally acceptable ... criminal law began to be used to warehouse American minorities and maintain their unequal status." [Mann, 1993; p. 127] David Cole, a professor at Georgetown University Law Center and an attorney with Center for Constitutional Rights, who studied unequal racial justice in the U.S. claims that "our [the U.S.] criminal justice system affirmatively depends on inequality" [Cole, 1999; p.5] He claims that in the absence of race and class disparities the criminal justice system could not have afforded the policy of mass incarceration pursued since the 1980s. Cole claims that African Americans, who constitute 12 percent of the general population, comprise more than half of the prison population and have higher arrest and conviction rates, serve longer sentences, face higher bail amounts and are often victims of police use of deadly force than white citizens. [Cole, 1999; p.4] According to Cassia Spohn, blacks and Hispanics who are young, male, and unemployed are particularly more likely than their white counterparts to be sentenced to prison and receive longer sentences in some jurisdictions. Spohn's study also claim that minorities convicted of drug offences, those with longer prior criminal

Effectiveness of Support for Children in Homeless Families

Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric Effectiveness of Support for Children in Homeless Families Effectiveness of Support for Children in Homeless Families The whole issue of parents and children in need is a vast, complex and ethically challenging one. This review is specifically charged with an examination of those issues which impinge upon the stresses and strains that are experienced by parents of children in need. A superficial examination of these issues that are involved in this particular area would suggest that there are a number of â€Å"sub-texts â€Å"which can all give rise to this particular situation. Firstly, to have child in need is clearly a stressful situation for any parent.(Meltzer H et al. 1999) This can clearly be purely a financial concern and a reflection of the fact that the whole family is in financial hardship, perhaps due to the economic situation or perhaps due to the actions of the parents themselves. Equally the need of the child can be a result of anon-financial need, so we should also consider the child who is in some way handicapped, ill, emotionally disturbed or perhaps in need in some other way. This produces another type of stress on the parent, and these stresses are typically longer lasting and, in general, less easily rectified than a purely financial consideration of need. (Hall D1996). It is part of the basic ethos of the welfare state that it should look after its less able and disadvantaged members. (Welsh Office 1997).Parents of children in need will often qualify in this definition. We shall therefore examine the various aspects of this problem. Literature Review Effectiveness of family support for children in homeless families We will make a start by considering one type of child in need. The first paper that we will consider is that of Prof. Vostanis (Vostanis2002), which looks at the mental health problems that are faced by deprived children and their families together with the effectiveness of the resources that are available to them. It is a well written and well researched paper, if rather complex and confusing in places. We will consider this paper in some detail as it provides an excellent overview of the whole area. The paper starts with a rather useful definition for our purposes. It qualifies the deprived child, initially in terms of a homeless family, that being : A family of any number of adults with dependent children who are statutorily accepted by local authorities (housing departments) in teak, and are usually accommodated for a brief period in voluntary agency, local authority or housing association hostels. This period of temporary accommodation can vary enormously depending on the time of year and the area considered, and can range from a few days to perhaps several months. The target in Greater London is currently storehouse homeless families within 4-6 weeks. In London particularly, the homeless families can be placed in Bed Breakfast accommodation.(D of H 1998) In this respect, the immediate family support mechanisms do appear tube in place. Vostranis however, goes on to make the observation that despite the fact that the definition of the homeless family is rather broad, it does not cover all of the potential children in need, as those children and their carers who have lost their homes but have managed to live with relatives, on the streets or perhaps live as travellers, are not covered by the statutory obligation to provide housing. The official figures therefore, he observes, are generally an underestimate of the true situation. The official figures for the homeless families are put (in this paper) at 140,000. (Vostanis Cumella, 1999) The authors give us further information in that many families will become homeless again within one year of rehousing and the typical family seen is the single mother and at least two children who are generally under the age of 11 yrs. They also observe that the typical father and adolescent child tend to be placed in homeless centres. (Doff H 1995) In exploration of the particular topic that we are considering, the authors give us the situations that typically have given rise to the degree of parental stress that may have led to the homelessness. They point to the fact that a homeless family is usually homeless for different reasons to the single homeless adult. Vostanis (et al 1997)is quoted as showing that 50% of the cases studied were homeless as direct result of domestic violence and 25% as a result of harassment from neighbours. The authors observe that the numbers in this category(and therefore the problems), are rising. (Welsh Office 1999). There are a number of section to this paper which are not directly referable to our considerations. We shall therefore direct our attention purely to those parts that have a direct bearing on the subject. One particularly useful and analytical part of the paper is the section that details the characteristics and needs of the target group. This is a very detailed section, but it makes the point that the children in need in this group are particularly heterogeneous, generally all with multiple and inter-related needs. Homelessness is seldom a one off event. This particular observation, (say the authors),is crucially important for the development and provision of services. Most families have histories of previous chronic adversities that constitute risk factors for both children and parents (Bassuk et al,1997). Such events include family conflict, violence and breakdown; limited or absent networks for family and social support; recurring moves; poverty; and unemployment. Mothers are more likely to have suffered abuse in their own childhood and adult life and children have increased rates of placement on the at-risk child protection register, because of neglect, physical and/or sexual abuse. If we specifically consider the health needs of this population, the authors categorise them thus: The children are more likely to have a history of low birthweight, anaemia, dental decay and delayed immunisations, to be of lower stature and have a greater degree of nutritional stress. They are also more likely to suffer accidents, injuries and burns. (BPA 1999) Some studies have found that child health problems increase with the duration of homelessness, although this finding is not consistent. Substantial proportion of homeless children have delayed development compared with the general population of children of a similar chronological age. This includes both specific developmental delays, such as in receptive and expressive language and visual, motor and reading skills, as well as general skills and educational status (Webbet al. 2001). It is for this reason specifically, that it has proved extremely difficult to assess the effectiveness of the family support services because of the multivariate nature of the problems that are presented. The authors point to the fact that one of the prime determinants of the degree of support available, is the actual access that the families have to these services. Many sources (viz. Wilkinson R 1996), equate the poor health of the disadvantaged primarily with the lack of access to services. One immediate difficulty is the current registration system in the UK. In order to be seen in the primary healthcare team setting, one must be registered with a named doctor. In the majority of cases that we are dealing with here, they have moved area and registration is probably not high on their list of priorities. One can argue that there is the access to the A E departments of the local hospitals but there is virtually no continuity here and they arena geared up to provide anything other than immediate treatment. (HallD 1996). This fact restricts their access to primary healthcare team procedures such as immunisations and other preventative medicine health clinics.(Lissauer et al, 1993) . By the same token these groups also have restricted access to the social services, whether they be the access teams, the family teams or the family support units and other agencies. The authors also point to other more disruptive trends in this group such as an inability to attend a particular school for fear of being tracked by an abusive partner. It follows that these children do not have a stable social support of a school. They are denied such factors as peer groups, routines and challenges which are both important protective and developmental factors. (Shankleman J et al2000). The summation of all of these factors, and others, is that the effectiveness of the family support services is greatly reduced by the mobility and the transient nature of the family unit. Quite apart from the difficulties outlined above relating to the problems of access to avenues of help open to the child in need and their families there are the problems engendered by the fact that social service departments indifferent areas of the country may not have immediate access to the previous records giving rise to many potential, and real, problems with continuity of care. This problem is brought into more immediate focus when one considers the increased frequency of child protection registrations in this particular group. (Hall D et al 1998). One specific analysis of the family support services of this particular group comes in the form of the psychiatric services. In the context of the title of this piece, it demonstrates how these particular services,(but not these alone), are failing to deal with the totality of the problem. All of the aspects that we have outlined so far are conspiring to dilute the effectiveness of the services provided. The fact that they are a mobile population with no fixed address means that some of the services may choose to invoke this as a reason for not making provision for them, particularly if resources are stretched. If more resources are given, then they are typically preferentially targeted at the single adult homeless population where the need is arguably greater. The authors of this paper point to the fact that this may not actually be true as some studies have shown that homeless single mothers and their children have a 49% psychopathy rate and only an 11% contact with the support services. (Cumella et al, 1998). The impact of this fact on the children can only be imagined. To an extent however, it can be quantified as the authors cite other studies which show a 30% need rating for children, (they do not actually define exactly what their perceived level of need was), contrasted with a 3% contact rate for children and adolescents in this area. (viz. Power S et al. 1995). Suggestions for improvement Putting these considerations together, the authors outline a set of proposals which are designed to help improve the access to some of the essential services. The model that they propose could, if successful and with a degree of modification, prove suitable for adaptation to other areas of the family support services. It is not appropriate to discuss this model in detail, but suffice it to say that it has tiered structure so that the degree of distress and need is titrated against the degree of input generated. One of the reasons that we have selected this particular paper to present in this context is for its last section. It proposes a â€Å"family support services model† which has been developed and pioneered in the Leicester area. In the context of our review, it is worth considering in some detail. A service provided through a family support team (four family support assistants).This is designed to detect a range of problems at the time of crisis; manage a degree of mental health problems (behavioural and emotional); provide parenting-training; support and train housing(hostel) staff; co-ordinate the work of different agencies; and provide some continuity after rehousing by ensuring intake by appropriate local services. The family workers are based at the main hostel for homeless children and families. Other, predominantly voluntary, services have established alternative posts, such as advocates and key workers. Whatever the title of the post, it is essential that the post-holder has some experience and on-going training in mental health and child protection, so that he or she can hold a substantial case-load, rather than merely mediate between already limited services. The family support workers have direct access to the local child and adult mental health services, whose staff provide weekly outreach clinics. Their role is to work with the family support workers another agencies, assess selected children and families, and provide treatment for more severe problems or disorders such as depression, self-harm and PTSD. A weekly inter-agency liaison meeting at the main hostel is attended by a health visitor, representatives of the local domestic violence service and Sure Start, There are also close, regular links with education welfare and social services. The aim is to effectively utilise specialist skills by discussing family situations from all perspectives at the liaison meeting. A bimonthly steering group, led by the housing department, involves senior managers representing these agencies, as well as the education and social services departments and the voluntary sector, and they oversee and co-ordinate the service. This appears to be something of an exemplar in relation to services provided elsewhere. The paper does not provide any element of costing sin this area neither does it provide any figures in relation to its success rates, contact rates or overall effectiveness. In conclusion this paper is an extremely well written and authoritative overview of the situation relating to the stresses of the homeless parent with children and the effectiveness (or lack of it) in its ability to reduce the stresses experienced by the homeless children in need and their parents. It proposes remedies but sadly it does not evaluate the effectiveness of those remedies. The effectiveness of the support services on families of children with psychiatric morbidity In order to address these shortcomings we can consider another paper by Tickler (et al 2000). This looks at a similar outreach set up which has been designed to capture the families of children in need who might otherwise slip through the net. This paper is written from different perspective and specifically analyses the effectiveness of these services as they pertain to an entry cohort of 40 families. This particular study was set up after preliminary work was done in the Birmingham area with 114 homeless families and this study defined the needs of the families but did not quantify their support systems.(Vostanis et al 1998). This paper set out to identify and measure the support systems available and their effectiveness as far as the families were concerned. The stresses encountered were partly reflected by the incidence of psychiatric morbidity. The mothers in the group were found to have over 50% more morbidity than a matched control group. The children in the group were found to have â€Å"histories of abuse, living in care, being on the at-risk protection register, delayed communication and higher reported mental health problems.† Allot which adds to the general background stress levels. (Kerouac S etal. 1996). This particular study found that despite the psychiatric morbidity in the children, (estimated to be about 30%), and the psychiatric morbidity in the parents, (estimated at about 50%), only 3%of the children and 10% of the parents had had any significant contactor support from the social services. In this respect, this paper is very useful to our purpose as it quantifies the levels of intervention and access to healthcare resources that this particular group has. By any appreciation, it would be considered woefully inadequate in any society that calls itself civilised. In the terms of the title of this piece, the effectiveness of the family support services is minimal. Suggestions for improvement Like the last paper discussed, this one also considered how best to tackle the problem, and this one is of much greater value to us, as it specifies a response, or intervention, to the problem in much the same way as the Vostranis 2002 paper did, but it makes the same measurements as it did prior to the intervention, and therefore allows us an insight into the actual effectiveness of the intervention. The way this particular study worked was to assess the problem (as it has been presented above), devise an intervention strategy and then to measure its effect. This particular study goes to great lengths to actively involve all the appropriate agencies that could help the situation by having a central assessment station that acted as liaison between all of the other resources. In brief, it actively involved liaison with the following: Education, social services, child protection, local mental health services, voluntary and community organisations to facilitate there-integration of the family into the community, and particularly their engagement with local services following rehousing; and training of staff of homeless centres in the understanding, recognition and management of mental illness in children and parents. This is essential, as hostel staff often work in isolation and have little knowledge of the potential severity and consequences of mental health problems in children. It was hoped that, by doing this, it would maximise the impact that the limited resources had on reducing the levels of morbidity and stress in the families of the children in need. Results The post intervention results were, by any estimate, impressive considering the historical difficulty of working with this particular group (OHara M 1995). 40 families (including 122 children) were studied in detail. The paper gives a detailed breakdown of the ethnic and demographic breakdown of the group. By far the biggest group were single mothers and children (72%) The results showed that the majority of referrals were seen between1-3 times (55%), with a further 22% being seen 4-6 times. It is reflection of the difficulty in engaging this type of family in need that over 25% did not actually keep their appointments despite the obvious potential benefits that could have been utilised. The authors investigated this group further and ascertained that a common reason for nonattendance was the perception that the psychological welfare of the children was not actually the main concern. The families perceived that their primary needs were rehousing and financial stability. Other priorities identified were that physical health was a greater priority than mental health. The authors also identify another common failing in the social services provision, and that is the general lack of regular contact. They cite the situation where some families cope well initially, apparently glad to have escaped an abusive or violent home situation, but a prolonged stay in a hostel or temporary accommodation may soon precipitate a bout of depression in the parents and behavioural problems in the children of such parents. (Brooks RM et al 1998). They suggest that regular re-visiting of families who have been in temporary accommodation for any significant length of time should be mandatory. This paper takes a very practical overview by pointing out that workability of the system is, to a large extent, dependent on the goodwill of a number of committed professionals. The authors state that this has to be nurtured and they call for sufficient funding must be given to enable this particular model to be extended to a National level. Thus far in the review we have considered the effectiveness of the service provision in the support of the families of the children in need in one specific target grouping, those who are stressed by virtue of the fact that they are homeless. We will now consider the literature on a different kind of family stress, and that is when a parent dies. This leaves the children with a considerable amount of potential emotional â€Å"baggage† and the surviving parent with an enormous amount of stress. (Webb E 1998). Effectiveness of support services in the case of parental bereavement An excellent paper by Downey (et al 1999) tackles this particular problem with both sensitivity and also considerable rigour. It is a long and complex paper, but the overall aims and objectives are clear from the outset. The structure of the paper is a prospective case study which aims to assess whether the degree of distress suffered by a family during a time of bereavement is in any way linked to the degree of service provision that is utilised. The base line for this study is set out in its first two paragraphs. Parentally bereaved children and surviving parents showed a greater than predicted level of psychiatric morbidity. Boys had greater levels of demonstrable morbidity than did girls, but bereaved mothers showed more morbidity than did bereaved fathers. Children were more likely to show signs of behavioural disturbance when the surviving parent manifested some kind of psychiatric disorder. (Kranzler EM et al 1990). The authors point to the fact that their study shows that the service provision is statistically related to a number of (arguably unexpected[Fristad MA et al 1993]) factors namely: The age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Paradoxically the level of service provision was not found to be statistically significantly related to either the parental wishes or the degree of the psychiatric disturbance in either the parent orchid. (Sanchez L et al 1994) The service provision did have some statistical relationships but that was only found to be the manner of the parental death and the actual age of the child at the time. The authors therefore are able to identify a mismatch between the perceived need for support and the actual service provision made. Part of that mismatch is found to be due to the inability of the social services and other related agencies to take a dispassionate overview. Elsewhere in the paper the authors suggest that there are other factors that add to this inequality and they include lack of resources and a lack of specificity in identifying children at greatest risk.(Harrington R 1996) The authors examine other literature to back up their initial precept that bereaved children have greater levels of morbidity. They cite many other papers who have found distress manifesting in the form of â€Å"anxiety, depression, withdrawal, sleep disturbance, and aggression.†(Worden JW et al. 1996) and also psychological problems in later life(Harris T et al. 1996). In terms of study structure, the authors point to methodological problems with other papers in the area including a common failing of either having a standardised measure or no matched control group(Mohammed D et al 2003). They also point to the fact that this is probably the first UK study to investigate the subject using a properly representative sample and certainly the first to investigate whether service provision is actually related to the degree of the problems experienced. The entry cohort involved nearly 550 families with 94 having children in the target range (2-18). With certain exclusions (such as two families where one parent had murdered the other etc.) and no respondents, the final cohort was reduced to 45 families and one target child was randomly selected from each family. It has to be noted that the comparatively large number of on-respondents may have introduced a large element of bias, insofar as it is possible that the families most in need of support were those who were most distressed by the death of a family member and these could have been the very ones who chose not to participate. (Morton V et al2003) The authors make no comment on this particular fact. The authors should be commended for a particularly ingenious control measure for the children. They were matched by asking their schoolteacher to complete an inventory of disturbed behaviour on the next child in the school register after the target child. A large part of the paper is taken up with methodological issues which ( apart from the comments above) cannot be faulted. Results In terms of being children in need, 60% of children were found to have â€Å"significant behavioural abnormalities† with 28% having scores above the 95th centile. In terms of specific service support provision, 82% of parents identified a perceived need for support by virtue of the behaviour of their children. Only 49% of these actually received it in any degree. Perhaps the most surprising statistic to come out of this study waste fact that of the parents who were offered support 44% were in the group who asked for it and 56% were in the group who didn’t want it. The levels of support offered were independent of the degree of behavioural disturbance in the child. Suggestions for improvement As with the majority of papers that we have either presented here or read in preparation for this review, the authors call for a more rationally targeted approach to the utilisation of limited resources. The study also provides us with a very pertinent comment which many experienced healthcare professionals will empathise with, (Black D1996), and that is: Practitioners should also be aware that child disturbance may reflect undetected psychological distress in the surviving parent. While not suggesting that this is a reflection of Munchausen’s syndrome by proxy, the comment is a valid reflection of the fact that parental distress may be well hidden from people outside of the family and may only present as a manifestation of the child’s behaviour. (Feldman Met al. 1994) The conclusions that can be drawn from this study are that there is considerable gap in the support offered ( quite apart form the effectiveness of that support) in this area of obvious stress for both parents and children. (Black D 1998). This study goes some way to quantifying the level of support actually given in these circumstances. Effectiveness of support in families where there is domestic violence We have considered the role of the effectiveness and indeed, even the existence, of adequate support services for the children in need and their parents in a number of different social circumstances. The next paper that we wish to present is an excellent review of the support that is given to another specific sub-group and that is women and children who suffer from domestic violence. Webb and her group (etal 2001) considered the problem in considerable (and commendable) depth The study itself had an entry cohort of nearly 150 children and their mothers who were resident in a number of hostels and women’s refuges that had been the victims of family violence at some stage in the recent past. The study subjected the cohort to a battery of tests designed to assess their physical, emotional and psychological health, and then quantified their access to, and support gained from, the primary healthcare teams and other social service-based support agencies. This study is presented in a long and sometimes difficult tread format. Much of the presentation is (understandably) taken up with statistical, ethical and methodological matters – all of which appear to be largely of excellent quality and the result of careful consideration. Results The results make for interesting and, (in the context of this review), very relevant reading. Perhaps one of the more original findings was that nearly 60% of the child health data held by the various refuges was factually incorrect. This clearly has grave implications for studies that base their evidence base on that data set(Berwick D 2005). Of great implication for the social services support mechanisms was the finding that 76% of the mothers in the study expressed concerns about the health of their children. Once they had left the refuge there was significant loss to the follow up systems as 15% were untraceable and25% returned to the home of the original perpetrator. The study documents the fact that this particular group had both high level of need for support and also a poor level of access to appropriate services. In the study conclusions, the authors make the pertinent comment that the time spent in the refuge offers a â€Å"window of opportunity† for the family support services to make contact and to review health and child developmental status. This is not a demographically small group. In the UK, over 35,000children and a parent, are recorded as passing through the refuges each year, with at least a similar number also being referred to other types of safe accommodation. Such measures are clearly not undertaken lightly with the average woman only entering a refuge after an average of 28separate assaults. One can only speculate at the long term effects that this can have on both the mother and the children. Suggestions for improvement In common with the other papers reviewed, this paper also calls for greater levels of support for the families concerned as, by inference, the current levels of effectiveness of the family support services is clearly inadequate. Conclusions This review has specifically presented a number of papers which have been chosen from a much larger number that have been accessed and assessed, because of the fact that each has a particularly important issue or factor in its construction or results. The issue that we have set out to evaluate is the effectiveness of the family support services which are specifically aimed at reducing the stress levels for the parents of children in need. Almost without exception, all of the papers that have been accessed (quite apart from those presented) have demonstrated the fact that the levels of support from the statutory bodies is â€Å"less than optimum† and in some cases it can only be described as â€Å"dire†. Another factor that is a common finding, is that, given the fact that any welfare system is, by its very nature, a rationed system, the provision of the services that are provided is seldom targeted at the groups that need it the most. One can cite the Tickler (et al 2000)and Downey (et al 1999) papers in particular as demonstrating that substantial proportion of the resources mobilised are actually being directed to groups that are either not requesting support or who demonstrably need it less than other sectors of the community. Some of the papers (actually a small proportion) make positive suggestions about the models for redirecting and targeting support. Sadly, the majority do little more than call for â€Å"more research to be done on the issue†. In overview, we would have to conclude that the evidence suggests that the effectiveness of the family support services in reducing stress and poverty for the parents of children in need is poor at best and certainly capable of considerable improvement. References Bassuk, E., Buckner, J., Weiner, L., et al (1997) Homelessness in female-headed families: childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248 1997 Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Black D. 1996 Childhood bereavement: distress and long term sequelae can be lessened by early intervention. BMJ 1996; 312: 1496 Black D. 1998 Coping with loss: bereavement in childhood. BMJ 1998; 316: 931-933 BPA 1999 British Paediatric Association. Outcome measures for child health. London: Royal College of Paediatric