Cause and effects of going without sleep Essay Example | Topics and Well Written Essays - 250 words

Cause and effects of going without sleep - Essay Example The inability to cope with stress results in emotional disturbances (such as anxiety, fear, and worry), overthinking, and restlessness preventing an individual from sleeping. Besides stress, other psychological factors that cause insomnia include psychological disorders (both personality and clinical mental disorders) and traumatic experiences (such as rape, close encounter with death or the death of a loved one). Conversely, insomnia might result from physiological complications. The brain is ultimately responsible for controlling sleep in human beings. The pre-optic area of the hypothalamus (anterior part) is the part of the brain that controls sleep. Therefore, damage to this area of the brain from accidents might cause insomnia. Other physiological factors that might cause insomnia include coronary diseases, cancer or respiratory diseases among others. Some medications used to treat diseases might affect regular sleep patterns among individuals. Finally, social factors that might contribute to insomnia include dysfunctional social interactions. For example, physically or verbally abusive relationships are a major cause of stress, which in turn affects different aspects of an individual’s life including sleep. The recreational use of some drugs and substances also affects the sleeping pattern. For example, caffeine found in coffee and Khat all cause insomnia (Brodsky & Brodsky 67) . In conclusion, the effects of insomnia are also explicable using a bio-psycho-social approach. Insomnia impairs optimum mental functioning. Fatigued individuals are highly irritable, which puts a strain on their social interactions. For example, they are prone to emotional outbursts and fits of rage both at home and at the workplace. In addition, insomnia impeded speedy recovery of sick individuals (Brodsky & Brodsky

Hepatitis Essay Example | Topics and Well Written Essays - 1500 words

Hepatitis - Essay Example To better understand the viral infection, it would be necessary to examine both acute infections and chronic infections of the virus. Chronic Hepatitis is the less common of the two but it can stay with a person for years. Often the symptoms are quite mild and the person may attribute them to other causes since the liver is not suddenly and significantly damaged (Ryder and Beckingham, 2001). In certainly cases, the liver damage progresses to a stage where cirrhosis may occur followed by liver failure or liver cancer. The cause for Chronic Hepatitis is most often the presence of the Hepatitis C virus since more than 75% of acute Hepatitis C patients develop Chronic Hepatitis. Hepatitis B and D variants of the virus can also cause Chronic Hepatitis but Hepatitis A and E variants do not (Merck, 2003). The causes for Chronic Hepatitis are many and complex even so that some medicines such as Methyldopa, Nitrofurantoin and even Tylenol can lead to chronic hepatitis. The risks are quite strong when these medicines are taken for a prolonged period of time. Similarly, Wilson’s disease which is a hereditary disease can also cause chronic hepatitis in children (Merck, 2003). The problem of detection for Chronic Hepatitis is compounded by the difficulty in marking the symptoms of the disease. For example, the symptoms include a feeling of sickness, poor appetite and a loss of energy (Ryder and Beckingham, 2001). Additionally, a person suffering from Chronic Hepatitis may have a low grade fever and abdominal pains. S/he may also develop signs of jaundice, have an enlarged spleen, retain fluid or blood vessels in the skin that look like spiders. When a doctor suspects a case of Chronic Hepatitis, a liver biopsy may be recommended as a diagnostic test for the liver. The biopsy can reveal the underlying causes of the disease and may be needed more than

Effects of the Tourism Sector on Employment Rates

Effects of the Tourism Sector on Employment Rates Chapter 2: Literature Review The main purpose of this chapter is to provide an overview of the existing literatures that various researchers have conducted on tourism and employment. This chapter also shed lights on how tourism sector is important for employment. 2.1 Theoretical Review The theoretical literature explores all the theories based on tourism and employment. 2.2 Introduction Around the world tourism has become the most crucial and fast growing industry as it is bringing a numerous advantages especially in Small Island like Mauritius. Over the last decades, tourism has attained increasing recognition as a crucial sector with enormous potential for generating employment. Tourism has been classified as the prosperous industry and considered as one of the largest and most progressive industries in the world that can bring maximum advantage to a country as compared to other economic activities. There has been a rise in tourist’s arrivals during the recent years since the beginning of civilisation as travel has been a great interest for people especially in Mauritius. UNWTOs Tourism 2020 vision foresees that international tourists arrivals are expected to be over 1.56 billion in the year 2020 thus this will bring a positive impact in job opportunities in the future as it will boost up the employment rate in the world. As such, the tourism sector will co ntinue to be a promising industry in the following decades. In a country such as Mauritius, employment is considered as one of the most important matters as unemployment keep on increasing every day. Unemployment following a period of seasonal job creation may be voluntary or involuntary. It is more efficient in creating employment in tourism than in any other sector as tourism is a labour intensive industry. Consumption expenditures of tourist provide direct or indirect employment opportunities in the tourism industry. Therefore total employment in a country is influenced by tourism via the general employment effect in the economy. The rapid growth of international tourism has led to numerous job creations. Tourism can create employment directly through hotels, restaurants, souvenir sales, taxis and nightclubs, and indirectly through the supply of commodities needed by tourism-related businesses. 2.3 The seasonality in tourism employment Tourism seasonality is an important issue in many destinations. Seasonality creates the variation in tourists and visitor numbers to a destination. Many countries are affected by seasonal employment in their tourism industry especially in coastal destination. Seasonality is considered more as an issue rather than a benefit of tourism (Butler, 2001). Thus seasonality is seen as a problem to be tackled at an operational level. Flognfedt (2001) disagrees that in certain situation seasonality in demands present opportunities to rural destinations mostly where their economy balances tourism alongside other activities. However it is considered that seasonality can cause problems for employment level in the economy. Unemploymentis not certainly produced by seasonal employment. Unemployment that occurs due to seasonal employment may be willingly or unwillingly because some employees prefer seasonal job as they are paid more compared to other job. Anyunemployment benefitpolicy designed to alleviate the seasonal nature of employment insectorssuch astourism may reduce the unemployment issue. Employment in the tourism sector is greatly affected by the phenomenon of seasonality. Marshall (1999) describes seasonal job as: â€Å"once the seasonal peak has been over, non-stable job will end at a stated time or in the future†. The perception of tourism seasonality can be described as temporal lack of balance in the phenomenon of tourism which can be signified in their expenditure, in the number of visitors and employment (Butler, 1994). The tourism sector gives the opportunity of complementary earning for local population in many developed and developing countries. However, particularly in many developed country destination seasonal fluctuation brings an irregular use of potential workforce which eventually lead to an increase in seasonal unemployment. The seasonal fluctuation of capacity use in tourism industry brings also a local shift of working area. Several countries reported efforts to prolong the high season by creating new artisanal products in order to attract more tourists in the whole year. This would solve the problem of seasonality employment as well as help to increase the investment yield. Furthermore in the Mauritian context, seasonality in tourist arrivals is also presented and hence this creates an imbalance of employment in the tourism industry where many people will be unemployed during this period. Usually the hottest months of the year are January and December where many foreigners come in Mauritius to spend Christmas and New Year in the summer season while other peaks are in the months of March and August where most of the European spends their holidays in Mauritius. However in June, the winter month in Mauritius and February, the cyclone prone month the country experienced a decreased in its tourist’s arrivals. According to the World Tourism Organization (UNWTO), there has been an increased in international tourist arrivals by 4 percent between the month of January and August 2012 compared with the year in 2011. Furthermore, total expenditure on tourism has also increased and most of the rise in spending was from travellers from developing countries suc h as China, and Indonesia. This generates more employment opportunities in the tourism industry. 2.4 The relationship between Tourism and Employment As tourism is a service industry it has powerful effect on those areas which has surplus of labour because skilled and productive human resources are very important for this sector. Tourism, due to its manpower intensive production by nature, is an industry creating an enormous opportunity of employment facilities. It has a great impact on local population employment. Thus there is a positive relationship between the growth of tourism and the increasing employment benefits. This also helps in reducing the poverty rate. A large number of professional and unprofessional people are required in the field of construction, advertisement and management of infrastructural facilities of tourist centres. The proper utilization of these available human resources could be a benefit for tourism improvement and side by side further prediction of employment. Any expenditure by a tourist allows this industry directly and allows other sectors which supply input to tourism sector indirectly to boost up employment opportunities. Tourism sector is directly linked with several industries such as accommodation, transport, entertainment, travel agents, management, finance and health. Moreover, tourism construction industry provides sources for other industries such as agriculture industry and manufacture industry indirectly. Furthermore, tourism may create job opportunities not only in tourist receiving countries but also in tourist sending countries in different aspect because different service units are needed in sender countries to complete some facilities done before travel. Depending upon development in tourism sector and intensity in demand for tourism there is an increasing effect in employment. The employment in a country increases as much as tourism demands for that country. Tourism creates employment as much as the income (Holloway, 1994). In addition, if we make comparison of employment rates created by tourism based on tourist sender country and tourist receiver country, it is possible to conclude in general that the employment rate in tourist receiver country is higher. Tourism appeared to be more labour intensive and empirical studies have confirmed that the level of employment in tourism activities is quite high. 2.5 Tourism creates an abundance of employment opportunities in both the informal and formal sectors. Tourism creates three types of employment in regional and national economies.( Mathieson and Wall) Direct Employment Tourism creates enormous number of direct employment in establishment like hotels, restaurants, tourist shops, travel agencies and also in transport, handloom and handicraft industries in the country and it meets touristic needs directly. It also generates certain category of workers like interpreters, guides, tour operators and so on. Indirect Employment Those directly employed in the tourism industry creates indirect employment in certain other sectors through their demand for the commodities. It covers the employment in other industries which do not cater for touristic consumers directly but get revenue from expenditure done in touristic relations that is the other sectors which bring input for tourism sector. For example, the workers to be employed in construction work of an additional unit to increase capacity of an accommodation facility, or the employees working in a manufacturing facility, which produces the goods to be put up for sale in this facility, can be considered in indirect employment. Induced Employment It refers to further employment in economy arising from re-spending of the income which has been acquired by direct and indirect employment approaches ( Mathieson and Wall, 1982). The individuals, whose earnings and standard of living have raised due to their tourism activities, create new job opportunities spending this acquired earning in other sectors of the economy. Multiplier effect of tourism plays an essential role in the development of induced employment. Mauritius has not been able to maintain its number one position in the regional rankings as it was overtaken by the entry of the Seychelles in the year 2013 and is ranked 58th overall. The priority of the sector remains high, along with a strong national attraction for Travel Tourism (ranked 6th). The country’s tourism sector and the good infrastructural development ground were ranked 48th and 37th respectively by regional standards. Travel Tourism is one of the dominant employment creators in the earth as this industry directly engages more than 98 million people, representing over 3 percent of employment rate in the world. The sector contributes to around one in every eleven jobs in the whole world. The share of world employment in Travel Tourism is greater than that for the auto manufacturing industries and chemicals manufacturing industries combined, across each and every region of the world. In addition, the outlook for the sector is almost positive as job growth in Travel Tourism is estimated to average 1.9 percent yearly over the following next ten years, compared with 1.2 percent growth yearly forecast for total jobs in the world. In all the regions of the world except for Africa, employment in Travel Tourism is foreseen to be more promising than total employment growth while travel and tourism employment in Africa is still expected to grow by 2.3 percent yearly for the next decades and reach 2.9 percent of total employment by 2022. Empirical literature review This section provides a brief description of the relevant empirical studies on tourism and employment. The main findings have been recorded, merged and compared where appropriate to build a model for analysing the impact of tourism on employment. Finally, the relationship between tourism and employment is examined. As tourism is a mixture of sectors and it consists of a great number of small service sectors, it becomes difficult to calculate exactly the tourism’s contribution in the country’s economy. However in Albania country it has been able to determine the relationship between tourism and employment in Albania during the year 1999 to 2012 and the empirical studies show that tourism has a positive impact on employment. Time series have quarterly data and their study has been done using Engle Granger test, Johansen Co integration and the correction of error. Thus empiric results show that tourism has had a positive effect on employment and the co-integration test has given result that there is a strong relationship between the two variables in the long run period. Furthermore, in Bermuda (dix 1989) concluded that 70 % of all employment in the island is supported by tourism. However when solely the direct employment is viewed the impact of tourism on employment is undervalued. That is real impact is far greater when taking into consideration the effect on the economy of both indirect and induced employment. A lack of accurate figure for total number of people employed in either indirect or induced tourism activities makes it difficult to calculate how many people are affected even though it is possible to estimate the impact of expected tourist expenditure on direct and indirect employment(mappisammeng 1991; Booth 1988). Varley 1978 considered that the volume of indirect employment generated by tourism was dependant on the degree of linkage between the tourism sector and the other sector in the economy. In his studies in Fiji he concluded that the higher degree of integration in the economy was the higher the amount of indirect employment creat ed. Further empirical studies have been done to illustrate the impact of tourism on national economy. Thus input-output analysis approach has been done to illustrate the economic impact of tourism. However Dwyer, Forsyth and Spurr argue that this type of models has some limitation and is considered as a disadvantage to use such type of model. They revealed that these models had taken into consideration only the positive economic aspect and has overlooked the negative impacts. Therefore they suggested that Computable general Equilibrium models (CGE) is a better technique to resolve the problem of the limitation.

Control, Empowerment, and the Fake World: Converging Metaphors :: Metaphors Education Educational Papers

Control, Empowerment, and the Fake World: Converging Metaphors "Metaphors not only structure the way we think about school, they also help create the world of the school" (Cunningham, "Metaphors of Mind" handout). This quote speaks the truth! Metaphors are the tools we use both to structure thinking about our culture and to create culture at the same time. An excellent example of this dual and interconnected role of metaphor is Marshall's belief that "the dominan t metaphor in many schools is SCHOOL IS WORK" (Cunningham, "MOM" handout). Marcel Danesi would say that this metaphor underlies a way to "conceptualize the world" of school (Danesi 107). By thinking about school in this way, the world of school is "crea ted" to be a work-filled experience. Students need to do homework and work harder at their lessons and teachers must manage their classrooms (Cunningham, "MOM" handout). It is in this way that the metaphor is the "cognitive phenomenon that converts fact ual feeling states into artifactual conceptual structures" (Danesi 107). Together, people create metaphorical ideas that turn into "real" artifacts, the representative structures of culture. The metaphorical idea of "school is work" pro duces the artifac tual world that fosters homework, working harder, earning grades, and managing classrooms (Danesi 108). These artifactual signs in turn perpetuate the controlling metaphor. Metaphors, then, are at the heart of understanding the way we view aspects of our culture while we simultaneously build that culture. Umberto Eco stresses that culture is a collective experience. In his view, "there is no such thing as a single mind, un connected to other minds or to their (collective) social cultural constructions" (Cunningham, "MOM" handout). If this is taken as fact, the "social, cultural, historical, and institutional contexts" humans find themselves in contribute to creating their metaphors and in turn, their artifactual worlds. Therefore, the situational context and the metaphors found there are intertwined and must be examined together. For example, I work in a juvenile prison. Prison is an interesting cultural context to investigate from its various perspectives. Many metaphors may be made about the same system depending on a person's immediate cultural group, or what Eco better terme d as humans' "local cultural organizations" (Cunningham, "MOM" handout). The sign of school and its object, the prison school program, has at least three distinguishable interpretants in the facility in which I work. These interpretants can be viewed as metaphors and are different depending on whose point of view and "local cultural organization" one is investigating.

Defined Marketing

Many people incorrectly believe that marketing and advertising are the same. From an organizational point of view, marketing is the process of determining the needs and wants of consumers, as well as profitable providing consumers with goods and services they are looking for, or even overcome their expectations. Marketing activity needs to ensure that the products are provided to users in places where they want them, and at the price they are willing to pay, and that information is provided directly by users. This paper will provide several definitions of marketing and explain its importance in organizational success, supported by examples from the business world. Dr. Philip Kotler defines marketing as â€Å"the science and art of exploring, creating, and delivering value to satisfy the needs of a target market at a profit. Marketing identifies unfulfilled needs and desires. It defines, measures and quantifies the size of the identified market and the profit potential. It pinpoints which segments the company is capable of serving best and it designs and promotes the appropriate products and services (Kotler, 2012)†. According to Kotler, marketing is also a social and managerial process by which individuals and groups – through creating, offering and exchanging products of value with others, are getting what they need or what they want. Peter Drucker wrote the following: â€Å"Because the purpose of business is to create and keep a customer, the business enterprise has two, and only two, basic functions: marketing and innovation. Marketing and innovation produce results; all the rest are costs. Marketing is the distinguishing, unique function of the business (Drucker, 1973). Marketing plays a central role in achieving organizational success, because it talks about creating and retaining customers. For this reason, companies are focused on marketing, recognizing the importance of building relationships with customers by providing customer satisfaction, and the importance of attracting new customers by creating additional value. Gronroos, in his definition of marketing, emphasizes the importance of building relationships, in which he said that the goal of marketing is to stablish, develop and commercialize long-term relationships with our customers, so that the objectives of stakeholders are met (1999, Gronroos). Since the majority of the market is characterized by fierce competition, this statement indicates a need to monitor and understand the competition, as rivals are those that will turn customers when their needs are not being met. In the exciting world of business, successes and failures are common. Marketing is the essence of all the changes, and it is often the decisive factor in their outcome. This is because the focus is on the customers and their changing needs. Successful organizations are those that are able, not only to get new customers, but also to retain them, by always meeting their changing needs. The company's activities are both reflected and shaped the world in which we live. Almost every year there is a new product or service that fully occupies the attention of the market and makes a great success. Companies are responding to customer needs by proposing that value by providing number of benefits that are offered to customers to meet their needs. Value of the intangible becomes physical, the proposal that may be a combination of products, services, information, and experiences. Brand represents an offer from a known source. Name brand, like McDonald's raises many associations with people: hamburgers, fun, children, fast food, coziness, and so on. These associations make up the brand image. All the companies are struggling to build a powerful brand – to be strong, popular and unique. The essence of the brand is to emotionally connect with consumers and achieve lasting impressions. It should be summed up in a few words, a simple statement that defines the quality, character and uniqueness of the brand. For example, Hallmark sums up the essence of their brand through two words â€Å"enriching lives,† and those two words are the basis for everything in Hallmark, the greeting card design, product development through customer service, merchandising, in-store communications and advertising, and to create a positive working environment for their employment. Hallmark brand essence permeates every aspect of the company and its operations. If we ask marketing and advertising experts around the world, what is the secret of Apple’s success, the answer would always be the same: It's all about the brand. Apple's success owes little to innovative products such as the iPhone, iPad or iPod. The key to their success is the brand that they created. It is no coincidence that during the '80s and '90s, executive marketing director and CEO of Apple, was the former CEO of Pepsi, John Sculley. It is he who, with the vision and energy of Steve Jobs, is responsible for the tectonic shift in the perception of marketing personal computers, which was created using the marketing strategy that was used in the war with Coca-Cola. That strategy has turned Apple into the largest computer company today. â€Å"People talk about technology, but Apple was a marketing company,† Sculley told the Guardian newspaper in 1997. â€Å"It was the marketing company of the decade (Kahney, 2002)†. The company that is aware of the barely noticeable changes that are taking place every day in the market has an advantage over a company that ignores those changes. The ability to anticipate future needs and to respond appropriately is a challenge that is always present in the marketing strategy of any organization. Despite the long tradition, there are no guarantees that all organizations will adopt marketing orientation. Companies that are marketing oriented, primarily focus on customer needs. The changes are seen as a common occurrence, and the ability to adapt is seen as a necessity for survival. The aim of marketing is a long-term customer satisfaction, rather than short-term deceptions and tricks.

Low cost strategy

As Jet Blue manages growth, the airline must also standardize many other things it does to avoid starting from scratch every time. For example, JetBlue has developed a checklist of what has to happen whenever it enters a new market. Everyone involved has access to the list on the corporate intranet. Each department sees what has been done, what remains to be done, deadlines, problems. Currently, the checklist makes launches that occur months apart more predictable. But before too long, it'll make simultaneous launches, unthinkable early on, manageable. JetBlue adopted a strategy for effective cost control by identifying and eliminating all unnecessary expenses and concentrating on providing high quality services to its passengers. Towards this end, it adopted a number of innovative measures on the planes such as: not serving food, point-to-point flights, and quick turnarounds. It also made effective use of advertising to position itself as a fun airline. JetBlue's innovative operational model helped it succeed at a time when the major players of the airline industry were crumbling. These activities and efforts are noteworthy and also improve efficiency, which will be critical in the years ahead as JetBlue tries to offset rising costs for aging planes and more-senior employees. And low costs remain an obsession. JetBlue's reservation agents, for example, work from home rather than in an expensive call center. At the same time, Neeleman is looking to widen profit margins again. A new 100-seat regional jet fleet being added next year will tap relatively uncontested — and so more profitable — markets. One of the latest tools designed to help JetBlue as it grows is an â€Å"operational recovery system.† During any disruption — weather that grounds some flights, for example — it allows planners to select various goals before rerouting planes. No canceled flights or delays beyond three hours? The software produces a solution and calculates its cost. It factors in each plane's maintenance and fuel needs, and the flight crew's experience and availability within FAA rules. With the current fleet of 57 planes, the program is a perk. Down the road, with 100 or more planes, it will be indispensable. (for more details, see the http://www.fastcompany.com/magazine official site)

Free Essays on Sexism In The Classroom

Sexism in the Classroom In â€Å"Failing at Fairness† one of the most important topics of sexism is addressed, and that of course is sexism in the schools. From the beginning of public education there is evidence of hidden sexism in the classroom, yet not until recently have researchers began to take a closer look at the dilemma at hand. Sexism in the classroom is not a problem that has just occurred overnight in schools. I believe that it has a history, staring long before I was born. I love to listen to the stories that my Grandparents share with me, as do many children my age. They always tell me how great those â€Å"good old days† were. Yet the stories make me step back and look at my grandparents, and see that those â€Å"good old days† are very different from today. Back then, the male role was heads of the household and they were responsible for any of the â€Å"physical work† to be done around the house. On the other hand, women had much less say in what was going on in the house, community, and even the nation. For the most part, women stayed home to take care of the kids and do all the housework that needed to be done. This has been the way of life for along time right up until the Second World War. Then slowly women began to work their way into the work force, leaving those elementary ideas behind. Through the years women have gained more and more rights focus on equality, but are they really equal? To some extent yes, and by law yes, but there are still those hidden views and ideas that are continually being pushed on society. I have always witnessed sexism in the classroom, even though I have attended catholic school all my life. I believe that it is more harmful if it is not that obvious. For instance, if sexism is taking place in a kindergarten class, and no one is there to correct it from the beginning, girls will feel like they are inferior to the boys and therefore hold back in participation. I ... Free Essays on Sexism In The Classroom Free Essays on Sexism In The Classroom Sexism in the Classroom In â€Å"Failing at Fairness† one of the most important topics of sexism is addressed, and that of course is sexism in the schools. From the beginning of public education there is evidence of hidden sexism in the classroom, yet not until recently have researchers began to take a closer look at the dilemma at hand. Sexism in the classroom is not a problem that has just occurred overnight in schools. I believe that it has a history, staring long before I was born. I love to listen to the stories that my Grandparents share with me, as do many children my age. They always tell me how great those â€Å"good old days† were. Yet the stories make me step back and look at my grandparents, and see that those â€Å"good old days† are very different from today. Back then, the male role was heads of the household and they were responsible for any of the â€Å"physical work† to be done around the house. On the other hand, women had much less say in what was going on in the house, community, and even the nation. For the most part, women stayed home to take care of the kids and do all the housework that needed to be done. This has been the way of life for along time right up until the Second World War. Then slowly women began to work their way into the work force, leaving those elementary ideas behind. Through the years women have gained more and more rights focus on equality, but are they really equal? To some extent yes, and by law yes, but there are still those hidden views and ideas that are continually being pushed on society. I have always witnessed sexism in the classroom, even though I have attended catholic school all my life. I believe that it is more harmful if it is not that obvious. For instance, if sexism is taking place in a kindergarten class, and no one is there to correct it from the beginning, girls will feel like they are inferior to the boys and therefore hold back in participation. I ... Free Essays on Sexism In The Classroom Sexism in the Classroom In their article "Sexism in the Classroom", Myra and David Sadker argue that sexism exists in the classroom and that boys are treated better than girls. The authors, Myra and David Sadker, talk about the research they did and what they observed over a three year period. They found that boys have a better opportunity of learning because they got more attention from the teacher and they observed that boys were often called on more than girls in the classroom. Their research also showed that the teacher gave boys more positive comments. Before I read this article I honestly never thought about sexism in the classroom. I believed boys and girls were given the same amount of attention in school. If I had thought there was sexism in the classroom, I would have guessed that girls were being favored over boys. In all of my classes in high school and in college I believe that females and males have been treated equally. This past week I observed my Spanish class to see if sexism exists in my classroom. The ratio of girls to boys in this class is 12 to 7. I observed that girls were called on more often than boys. Also, the teacher gave girls more positive comments than they gave to the boys. For example she told a few girls that they had worked well in their group and did a good job on the assignment But, most of the time she went around the whole class to get everyone to participate. I think that the teacher did a good job of trying to involve everyone in the lessons we were doing. There were more girls in my Spanish class and always more girls who raised their hands than boys. When we were put into groups, it seemed to me that girls contributed more to the group than the boys did. I also noticed this week that when we came into the classroom and sat down, it was mainly girls in the front of the classroom and mainly more boys towards the back of the classroom. It has been said that teachers often favor one side of ...

The Geography Of Start-ups Example

The Geography Of Start The Geography Of Start The Geography of Start-ups The geography of start-ups is an article in the Economist printed on October 27, both in the online and print edition. The article is an illustration of Alfred Marshall’s reasoning for firms located in a place geographically near each other. Alfred Marshall noted that proximity, created â€Å"something in the air†, which the article explains as data (The Geographies of Start-ups†, Par. 1). The article gives for economic theory reasons for proximity including proximity to natural resources, access to a pool of specialized labour, supply of specialized inputs, and spill-over of ideas. The article depicts the proximity of technology companies in Silicon Valley with increasing concentration in London, New York, Berlin, and San Francisco. Silicon Valley remains to be the home for most technology companies owing to the following reasons. The reasons behind the proximity of these firms according to the article are access to labour, money, and a dvice for start-ups. Other reasons are increased chances of face-to-face communication, which is more efficient than email of phone conversation. Recycling of people owing to experience, access to latest ideas, and ability to have access to venture capital are the other reasons for proximity of technology firms. The article goes further to analyse the possibility of other cities including New York, Berlin, and London catching up with Silicon Valley. Two advantages favour New York and Berlin, which are they are bigger and have a vast pool of industries resulting in high skills. The effect is the start of start-ups in these cities with Berlin having an advantage of technology and art intersection. Despite these advantages, Silicon Valley has had more scale and resilience in terms of proximity to information technology industries with the primary reason being data. I believe the article is clear and concise in articulating the different reasons reminiscent for the proximity of firms es pecially in Silicon Valley with the main reason standing out being access to data. Data in terms of new ideas and innovations that have proved to be technological milestones has held the Silicon Valley together and will continue owing to the increased benefit of communication, internet, and other technologies.Work CitedThe Geography of Start-ups. The Economist. October 27, 2012. Web. February 13, 2015.

The Odds of Winning the Lottery

The Odds of Winning the Lottery What are the chances that the lottery ticket that you’re holding in your hand is a winner? This sort of question is an applied probability problem. With millions of dollars on the line, it would be good to have a solid answer. What are the odds of winning the lottery? How Does The Lottery Work? To answer this sort of question we need to know how a lottery works. In lotteries, a person plays by buying a ticket with a choice of numbers from a certain range. At a specified time the organization running the lottery randomly generates numbers from this same range. The grand prize, sometimes worth several millions of dollars, is awarded for matching all of the numbers. In some lotteries, lesser amounts are paid for matching all but one or two of the numbers. Those are the generalities, but we need to know the specifics of the game that you purchased a ticket for. These specifics will calculate the exact probability that you have of winning. A Sample Game One game, known by various names such as Daily 4 or Pick 4, involves choosing four numbers from 0 to 9. The order of these digits is important, so 1234 is a different choice of digits than 1243 or 1324. The probability of winning this lottery is given by determining the total number of ​four-digit numbers possible. Since each of the numbers is chosen independently and there are ten choices for each, the total number of four digit numbers is 10410000. This means that the probability of winning is 1/10000 0.01%. Games of this sort typically do not pay that much and are not what people associate with winning the lottery. A typical payout for a $1 bet on a lottery such as this is $5,000. While this sounds good who wouldn‘t want to multiply their money by 5000 realize that on average you would have to play thousands of times to make winning likely. Another Lottery Game Another type of lottery game pays more if you win it, but it is much harder to win. An example is where six numbers are chosen from 1 to 48. Here the order of the numbers is not important, and so we need to calculate a combination. We can choose six number from 48 in a total of C(48, 6). By the combination formula this number is 48!/(6!42!) 12,271,512. As matching all of these numbers perfectly accounts for one of these combinations, the probability of matching and winning millions is 1/12,271,512. How Likely Is It? So those are the numbers, is there any good way to interpret them? Let’s look at the millionaire game and its probability of winning at 1/12,271,512. Winning this is very unlikely. To be assured of a 50% chance of winning you would need to buy over eight million different tickets. The number 12,271,512 is roughly that of the population of the entire metro area of Los Angeles, California. So the probability of winning the lottery is the same as running into a particular person, chosen in advance while walking the streets of LA. Another way of looking at this is to look at other probabilities. Numbers are somewhat hard to come by, but it’s been estimated that 100 people a year in the U.S. are struck by lightning. With the current population at 307 million, the probability that you will be struck by lightning this year is 100/307,000,000 1/3,070,000. So you’re four times more likely to be struck by lightning than to win the lottery. Sure, some people win millions in the lottery. It’s just very likely that it’s not going to be you.

Understanding business operations Essay Example | Topics and Well Written Essays - 2000 words

Understanding business operations - Essay Example per will examine current models of business operations by considering how these organizations might theoretically gain a competitive advantage by drawing on the examples of two organizations. One of the presented models will be based on an organization which is volume intensive and second will be based on a business model which is margin intensive. There is little question that technology is evolving rapidly, and the impact that these technological advances have on our modern economy can be profound. In this regard, organizations who have made every attempt to be constant and consistent innovators in technological development and application in their business models have reached an unparalleled success. Technological advances in such areas as supply chain, inventory management, distribution, and business monitoring has significantly affected the bottom line of a number of different businesses. For the purpose of this essay the first business model that will be examined is that of Wal-Mart and how the implementation of technology in their business organization has affected the way that we as consumers may have shifted our buying procedures. The format for this discussion is to give a brief background on Wal-Mart followed by a discussion as to how their innovation has helped make this organization the company it is today. There is little question that Wal-Mart is a truly global company which according to Reuters (2010) has operations in over fourteen nations with both retail and online sales in their portfolio. Wal-Mart has a focus on regular household items however the company has recently diversified into membership format retail operations as well as diversifying their product offerings to include groceries. One could theoretically define their product offerings to be in the traditional household retail sector. When questioned as to how Wal-Mart’s business model has affected the goods we buy and the choices available one must make an examination of

Is Oil a Blessing or a Curse for the Middle East Essay

Is Oil a Blessing or a Curse for the Middle East - Essay Example The reality that many nations face with regards to being nearly entirely dependent upon their natural resources as the basic foundation of their economies is referred to as both â€Å"renterism† and the â€Å"Dutch disease†. The first term, renterism has to do with the fact that these nations ultimately rent out the access to their resources in exchange for direct payments for such an agreement. Similarly, the term Dutch disease is with regards to the Dutch nation’s dependence upon the revenues from the natural gas fields in the 1960’s and 1970’s. For purposes of this brief analysis, the issue of the resource curse will be viewed within the prism of seeking to understand it as it is exhibited within the nations of Saudi Arabia and Iran. These two nations have been selected due to the fact that they are both regional powers that have defined their economies around the oil wealth that they possess; albeit through slightly different means. Moreover, ev en though a similar economic stance has been taken with regards to a centrally planned economy in both nations, the overall levels of extreme wealth and pervasive poverty, social divisions, non-democratic forms of governance, problems with radical forms of Islam, and a host of other byproducts of the uneven economic development that oil wealth dependence portends crates a great deal of similarity between these two nations. History and Background: Prior to the discovery of oil in Saudi Arabia and Iran, both of these regions were seeking to integrate at a rather rapid rate with the rest of the world by developing their economies and seeking to industrialize. Although it is not fair to say that these nations were particularly backwards as compared to their neighbors, they exhibited a relatively low level of growth and change as compared to Western Europe and parts of Asia at that time. It can be noted that within both Iran and Saudi Arabia, there existed and much more decentralized und erstanding of governance and power. Although it is not the purpose of this analysis to go into a great deal of defining the means by which resource wealth encourages further levels of despotism, it should be understood that once a high level of valuable resources are located within a given region, it necessarily encourages individuals within government to more fully and completely exert their control over these resources as a means of promoting sovereignty, stability, and deriving profitability; both for themselves and for the nation in general. A byproduct of this increased level of centralization and control is necessarily the loss of specific civil liberties and freedoms. Aside from the collapse of the Ottoman Empire and redefining the post-colonial borders, the discovery of oil and natural gas resources has had the most profound impact upon the course of development, politics, war, and even radical forms of Islam. With respect to the actual discovery of oil within the Middle Eas t, Iran was the first in 1908 (Neilberg, 2012) followed by Saudi Arabia in 1923 (Jones, 2012). Oil came to be an even more coveted resource to which all developed nations sought to procure. Accordingly, it was not abnormal to merely take over another country as a means of extracting its mineral wealth and diverting it back to the homeland. Such a model was utilized for nearly 25 years as the British extracted oil wealth from Saudi Arabia and Iran (Mainuddin, 2007). The ways in which key actors within

Bhakti and Karma in the Bhagavad Gita Research Paper

Bhakti and Karma in the Bhagavad Gita - Research Paper Example In the Bhagavad Gita, Lord Shri Krishna specifies another path for the human race to achieve salvation: â€Å"The Path of Bhakti† or â€Å"Bhakti Yoga†. The term â€Å"Bhakti† refers to devotion. In other words, deep and intense love is known as â€Å"bhakti† and the devotees who worship the Supreme Lord through the expressions of bhakti are called â€Å"bhaktas†. Spiritual seekers who are able to maintain their focus fixed on the Lord and who always worship Him with undaunting devotion and concentration, are able to attain perfection in their pursuits. In the words of the Lord â€Å"Those who worship Me as the Indestructible, the Undefinable, the Unmanifest, the Omnipresent, the Unthinkable, the Primeval, the Immutable, and the Eternal,†.Restraining their senses, if these devotees are able to maintain their composure in all circumstances of life and consistently work for the betterment of mankind, they are successful in attaining the Supreme Lord.Persons who submit their actions to Lord Krishna, who sincerely meditate on him, pray religiously to Him, whose minds are concentrated upon Him and whose thoughts center only around Him, are blessed with the mercy of the Lord. Lord Shri Krishna advises Arjuna and thus to the entire mankind to practice concentrating his mind and intellect only upon the Lord. If a person is unable to focus his mind following this method, but instead dedicates his life to the service of the Lord and performs all his actions for the sake of the Lord, he will still be able to attain the Supreme Creator.... The Lord gives his own example by saying that there is no action in this Universe which He is compelled to perform neither is there anything left for Him to achieve, yet he is consistently active. If the Lord were to abstain from action, the human race would be faced with chaos and would ultimately be destroyed. A person who does his duties following the Karma Yoga is ultimately able to attain the Supreme Creator. (Klostermaier, 122-123) In the Bhagavad Gita, Lord Shri Krishna specifies another path for the human race to achieve salvation: â€Å"The Path of Bhakti† or â€Å"Bhakti Yoga†. The term â€Å"Bhakti† refers to devotion. In other words, deep and intense love is known as â€Å"bhakti† and the devotees who worship the Supreme Lord through the expressions of bhakti are called â€Å"bhaktas†. (Meher Baba). Spiritual seekers who are able to maintain their focus fixed on the Lord and who always worship Him with undaunting devotion and concentrati on, are able to attain perfection in their pursuits. (Klostermaier, 185-186) In the words of the Lord â€Å"Those who worship Me as the Indestructible, the Undefinable, the Unmanifest, the Omnipresent, the Unthinkable, the Primeval, the Immutable, and the Eternal,†Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. (S. p.99; 12.3) Restraining their senses, if these devotees are able to maintain their composure in all circumstances of life and consistently work for the betterment of mankind, they are successful in attaining the Supreme Lord (S. p.99; 12.3). Persons who submit their actions to Lord Krishna, who sincerely meditate on him, pray religiously to Him, whose minds are concentrated upon Him and whose thoughts center only around Him, are blessed with the mercy of the Lord. The Supreme Creator rescues them from the cycle of life and death. Lord Shri

A Letter of Intent for Getting a Scholarship Essay - 3

A Letter of Intent for Getting a Scholarship - Essay Example Similarly, I am very altruistic, which often seems like a weakness in this rational and materialistic world. However, all these strengths and weaknesses have made me a stable and realistic person, who can bring some change in this globe. I have finished my Associates Degree in Accounting from Madison Area Technical College in the year 2005, before which I gave birth to my second child in March 2005. However, my passion for learning did not allow me to leave a single day from school, which depicts my emotional maturity and academic ability to complete my degree with effective implementation of intellectual competence. During these years, I have been able to manage my life through effective management of my responsibilities towards family, work, and school activities. It is very imperative that an individual should set realistic goals, and my desire to involve myself in a long-learning process has resulted in my application for achieving Bachelors in Accounting Degree from your reputable educational institution. Since I know that I have a passion for learning, and implement it in all areas of life, I know this can be achieved effectively through studying from achieving my goals. Our globe is a practical world that respects people with rationale, and therefore, it is imperative that individuals should set and organize realistic goals, in order to prolong learning process and achieve the required goals with the effective amalgamation of intellectual competence and emotional maturity. I have fully analyzed my financial situation and necessities that I will be requiring during my life, such as college expenses, household expenses, children’s education expenses, etc. At present, my employment of forty hours per week is providing me with funding to support myself, as well as, my family.  Ã‚  

Health Issues In Gender, Age and Ethnicity Essay

Health Issues In Gender, Age and Ethnicity - Essay Example makes the individuals have an inaccurate discernment of their appearance and have an intense feeling and need to lose weight even when they are thin, posing an harm to their health status. Anorexia is a common disorder among women in United Kingdom. According to the Royal College of Psychiatrists (2015), 95% of people suffering from anorexia in United Kingdom are women. Though the actual numbers of people suffering from anorexia is not known since most cases go undiagnosed, it is estimated that 5% of women aged between 15 and 30 in United Kingdom suffer from anorexia. The Royal College of Psychiatrists (2015) also suggests that women between the age of 15 and 30 have a high probability than men of suffering from anorexia. This makes women ten times more likely to suffer from anorexia. It is estimated that 10% of women in United Kingdom suffering from anorexia succumb to it every year. Anorexia is a common disorder among the age bracket of 15 to 30 years and may become severe leading to

Employee Recruitment and Selection Research Paper

Employee Recruitment and Selection - Research Paper Example Labour efficiency is achieved by employing people with the right skills for assigned jobs and balancing the right number of workers to do the job. Therefore, applicants should be carefully identified, targeted, and recruited for positions. This research report, focusing on the recruitment and selection of IT employees, preferably Information and Computer Science Graduates, for an international organisation will, following a review of the relevant theoretical literature, suggest a recruitment and selection technique which is cost effective, timely and, importantly, establishes an immediate correlation between targeted recruitment environment, candidate selection and job description. Â  In other words, drawing upon both empirical and theoretical literature, the report shall propose a recruitment and selection framework which is immediately informed by the job requirements, its associated tasks and responsibilities.Labour efficiency is achieved by employing people with the right skills for assigned jobs and balancing the right number of workers to do the job. Therefore, applicants should be carefully identified, targeted, and recruited for positions. This research report, focusing on the recruitment and selection of IT employees, preferably Information and Computer Science Graduates, for an international organisation will, following a review of the relevant theoretical literature, suggest a recruitment and selection technique which is cost effective, timely and, importantly, establishes an immediate correlation between targeted recruitment environment, candidate selection and job description. In other words, drawing upon both empirical and theoretical literature, the report shall propose a recruitment and selection framework which is immediately informed by the job requirements, its associated tasks and responsibilities. 2 Theoretical Overview There is a wealth of theoretical and empirical literature on employee recruitment and selection. This section shall review some of this literature with the purpose being the latter formulation of a best-practices framework for the recruitment and selection of 20 IT employees in the international firm referenced in the preceding. Appendix I presents an overview of the positions to be filled. 2.1 Recruitment Recruiting techniques to maximize not only the quantity of applicants, but also quality, are important because the screening process requires significant organizational resources (Sherman, Bohlander and Snell, 1996). IT positions take an average of 37% longer to fill than non-IT positions, ' search firm recruiting fees can be as high as 40 percent of annual salaryr3' and average costs may range from $7,500 to $25,000 per employee for all modes of recruiting combined. In addition to the direct costs, the difficult to measure, but undoubtedly more critical lost opportunity costs of not having necessary human resources, make IT recruitment a strategic imperative in the current economy (Mencken, 1998). Recruitment research has steadily increased over the past thirty years, including studies of the effect of selected recruitment sources on outcome. One of the earliest studies of recruitment sources and linkage to beneficial organizational outcomes compared results of informal versus formal sources. A primary difference between these two broad types of recruiting techniques is that formal recruitment involves a formal market intermediary between the organization and potential employee, Ullman's (1966) study discovered a lower turnover rate for employees recruited through informal sources (i.e. direct applications, referrals) than for those identified through formal approaches (i.e. advertising, employment agencies) . Subsequent research offered theoretical explanations for the relationship between source and outcome, most notably the "realistic information" hypothesis and the "individual difference" hypothesis. The " realistic information" hypothesis suggests that workers recruited throug

Health Issues In Gender, Age and Ethnicity Essay

Health Issues In Gender, Age and Ethnicity - Essay Example makes the individuals have an inaccurate discernment of their appearance and have an intense feeling and need to lose weight even when they are thin, posing an harm to their health status. Anorexia is a common disorder among women in United Kingdom. According to the Royal College of Psychiatrists (2015), 95% of people suffering from anorexia in United Kingdom are women. Though the actual numbers of people suffering from anorexia is not known since most cases go undiagnosed, it is estimated that 5% of women aged between 15 and 30 in United Kingdom suffer from anorexia. The Royal College of Psychiatrists (2015) also suggests that women between the age of 15 and 30 have a high probability than men of suffering from anorexia. This makes women ten times more likely to suffer from anorexia. It is estimated that 10% of women in United Kingdom suffering from anorexia succumb to it every year. Anorexia is a common disorder among the age bracket of 15 to 30 years and may become severe leading to

Local and National Provision of Hurling Essay Example for Free

Local and National Provision of Hurling Essay In this essay I will look at how Hurling is provided for in Belfast at grassroots level to representative level. I will also examine if there is any provision for those with disabilities to play Hurling and I will examine if there is any provision for different gender groups. I will then see what provision is available to play Hurling at national level and see how excellence is developed. The national governing body of hurling is the Gaelic Athletic Association (GAA). The National Organisation (G.A.A.) is run by Central Council (à rd Comhairle), with the Management Committee (Coiste Bainistà ­) controlling day-to-day affairs. They run the All-Ireland series of the club and county championships, and look after the Railway Cup competition. The Provincial Councils are the organisations responsible for the arrangement of G.A.A. matters within their Province. They organise the Provincial Championships for clubs and counties in both hurling and football, and look after organisational and disciplinary matters in their jurisdiction. Each of the thirty-two counties in Ireland organises its own GAA affairs through a County Board. Counties have a number of Divisional or Juvenile Boards to organise competitions at district and youth levels. The County Board (and / or subsidiary boards) will organise competitions for the clubs within its jurisdiction. They are also responsible for the organisation of teams to play at inter-county level, at all age groups from Under-10 to Senior. The G.A.A. has over 2,500 clubs in Ireland alone. The playing of Gaelic Games is based on the G.A.A/ Club, and each of the 32 Counties in Ireland have their own Club competitions, culminating in County Winners in championship and league. GAA Central Council (à rd Comhairle) Provincial Councils County Board Divisional or Juvenile Boards Clubs Young people in Belfast are catered to play hurling in a number of different ways. There are GAA clubs they can join which will take them from U8 right through to senior level, but there are also many competitions organised through schools and colleges. Clubs/County Schools U8/U10 Primary School Blitz tournament Inter School Competitions

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