Summary of the narrative life of frederick douglass, An american slave Essay

Summary of the narrative life of frederick douglass, An american slave - Essay Example His mother died without him knowing her well. At the age of seven, his mother's body was found dead in one of Frederick master's farm, near Lee's Mill. Having no slight intimation with his mother, he accepted her death like an ordinary death of a stranger, with no spark of pain in his heart. His first master was Captain Anthony. People by his time say that his master is his father by which he did not confirm to be a fact. Captain Anthony is a clerk and superintendent of Colonel Edward Lloyd. This man owns from three to four hundred slaves in his plantation. Every month the slaves receive their monthly allowance of food - eight pounds of pork or fish, and one bushel of corn. Aside from this, they also receive a yearly clothing of two coarse linen shirts and one pair of shoes. Just when he thought he is going to spend his entire life under the agony of slavery, suddenly hope came his way upon knowing that he was allowed by Captain Anthony to stay in Baltimore with Mr. Hugh Auld. He was between the age of seven and eight that time. By the time Frederick reached Mr. and Mrs. Auld's house, he had felt the warmest welcome he had ever experienced in his entire life. This was the first time he had ever seen the most pleasant faces of slaveholders. The city slave, unlike the slaves in the plantation, is almost a freeman. His stay to this place gave him the opportunity to learn the basics of English alphabet, through the help of Sophia Auld, his new mistress. But then, when her husband found out what she was doing, she had been forbidden to teach Frederick, for the reason that according to him, "learning would spoil the best nigger in the world." Frederick this time has to learn reading in his own perseverance, and to bring his dream into reality, he made friends with the white boys whom he encountered in the street that later on helped him succeed in learning to read. At the age of ten or eleven, he returned to his hometown, Holmes Hill Farm. This is because his master, Captain Anthony, died and all the slaves, including him have to be divided between his master's children, Mrs. Lucretia and Mr. Andrew. During this process, slaves were scrutinized before the division. No one wished to be a slave for Mr. Andrew for he is cruel and merciless like all other masters. Lucky enough, Frederick was chosen to be a slave for Mrs. Lucretia's and was sent back to Baltimore. Upon reaching the age when he could give dates, Frederick has left Baltimore to live with Master Thomas in March 1832. This time, he was sent to a guy named Mr. Covey. This guy claims to be religious, but has no heart for his slaves. He finds pleasures in whipping them all the time, and Frederick, being one of the slaves, did not escape this. He was beaten almost everyday until the time he thought it would be a benefit to take his own life. But the Ganadores 3 hope of freedom still lingers in his mind that stopped him from committing

Stem cell research Proposal Example | Topics and Well Written Essays - 1250 words

Stem cell - Research Proposal Example In addition to this, stem cells also help in the internal repairing of the organs by dividing themselves endlessly to cover up for the lost or damaged cells. The new cell which is formed by the stem cell division has the ability to either become another stem cell or a cell with a particular function. Because of its functions, its biological uses are endless. Human heart muscles can be rebuilt, as well as cartilage muscles, bones, neurons and skeletal muscles. Pancreatic cells can be developed for diabetes patients, neurons for people with Alzheimer’s and bone marrow for cancer patients. These are but a few uses to mention. (Gross) Stem cell technology is the best biological step towards repairing of damaged organs as well as creating new ones. The goal of using stem cells is to strap up the chemical signals by which stem cells synchronize the development of organs of a fetus in the womb, and then repeat the process in adulthood to reshape the damaged organs into a better susta inable condition. (KU medical centre) Up till now the research has only been conducted on mice but it is believed that this technology would soon be in practice. Researchers in Washington reported that the stem cells derived from the embryos have the potential to repair organs in two ways: The stem cells either take up the place of the wounded areas or by secreting vital chemicals which help tissues to repair themselves. (Info centre) Craig Basson, director of cardiovascular research at Cornell University's Weill Medical College in New York said "Most of the work on stem cells to date has focused on how to get these cells to turn into a heart cell, a kidney cell, a bone cell or whatever it is you need,". Biological materials like bone marrow, kidneys and even heart could be created out of a stem cell thus with proper utilization and work on this technique, these materials would become abundant. Heart deformities which previously had no cure and proved to be fatal could be cured by t he introduction of stem cells in the affected place as proved by the research and experiments. (KU medical centre) For the first time in the history of biological development, such a gigantic leap has been taken and it is believed, it would result in a positive turn on the life and health of the people. The future is supposed to hold a limitless reserve of the stem cells which would be readily available as per the demand of the user; the prospect of having a new pancreas as well as having your heart repaired with a few injections of stem cells is highly exciting. Abnormalities in blood cells and weak immune system in the people are constantly on the rise and even the youngsters are affected by this; stem cells offer a cure to these abnormalities. Heart diseases are the biggest problem faced by the patients around the world. (Kiessling) Most of the time, these result in death as heart transplants are exceedingly rare and repair of the organ without the stem cell is impossible. This i s the reason what makes heart an expensive biological material, making the treatment of these diseases very costly. In America alone, the total cost of treating cardiovascular diseases and stroke in 2004 is estimated to reach almost $368 billion. Introduction of stem cells would be a great relief for such patients and heart disease would tend to be less lethal. When put into practice,

Critical Evaluation Essay Example for Free

Critical Evaluation Essay The ancient Greek philosopher Thales was born in Miletus, in Greek Ionia. Aristotle the major source of Thales’ philosophy and science identified Thales as the first person to investigate the basic principles, for in the sixth century he broke away from explaining the natural phenomena through myths and adopted rational means of explaining it. In explaining the totality of all things, Thales described one primary material substance as the elemental foundation of all things, for he believed that there must be some natural substance either one or more than one from which other things come into being while it is preserved, and he postulated that this primary principle is water. Being an astronomer on the other hand he was believed to have predicted an eclipse in 585BC. It is therefore the purpose of this essay to critically evaluate Thales’ metaphysics in the context of aim, content and method of philosophy then proceed to clearly underscore his unique contribution to the development of philosophy. To begin with, as pointed out earlier on, Thales was the first philosopher to ask questions about the structure and nature of the cosmos as a whole and is known to be the founder of philosophy of physis which is the study of the totality of reality. Being the first philosopher, he affirmed the existence of a unique principle and cause of all things that exist. He said this principle is water because it is wholly from water that life itself comes from and into which it dissolves, he also declared that the earth rest on water getting the notion perhaps from seeing that the nutriment of all things is moist and that heat itself is generated from moisture and kept alive by it, and that from which they come to be is a principle of all things. He got his notion from this fact and from the fact that seeds of all things have a moist nature and that water is the origin of the nature of moist things (Guthrie, 1978: 55). By saying principle Thales meant the reality that remains identically the same throughput the changes in its characteristics and it continues to exist unchanged throughout the process of the generation of everything (Presocratics, 1995: 42). However, despite postulating that water is a principle, he also had two other propositions which came down from his verbatim and these were â€Å"magnet possesses the soul† because it is capable of moving things like iron, and that â€Å"all things are full of goods†. In saying this Thales implicitly implied that his water principle is the source, sustainer and font of all things and that he used the gods in his assertion for the people’s easy understanding of it (Radhakrishnan, 1953: 28). Having looked at a number of Thales’ assertions and their meanings, it is necessary that we clarify the aim of Thales as regards to philosophy. On this point Aristotle states that philosophy has a purely theoretical character, that is, it is contemplation, and that it simply seeks truth for its own sake. Philosophy is not sought because of any advantage that is extrinsic to it, but it is sought just for itself (Reale, 1978: 17). Therefore in this sense, as Thales was explaining the principle of all things he did not benefit any wealth from it and this is why he was mocked for his poverty, insinuating that his philosophy was of no practical use to him (Presocratics, 1995: 45). Since philosophy does not bake bread nor fix gadgets but rather aims primarily at knowledge, we then see that Thales without any practical benefits tries to find the origin of all things just for philosophy’s own sake. With respect to content, philosophy wanted to explain the totality of all things, that is, the whole of reality without the exclusion of any part or aspect of it, thus distinguishing itself structurally from the special sciences that instead are limited to explaining particular sections of reality, groups of particular things or particular phenomena. In trying to explain the whole of reality the first philosophers were asking the question, what is the principle of all things? (Reale, 1978: 17). Thales in responding to this question in accordance to the content of philosophy, he said water is the principle, for him, he did not necessarily consider the importance of water in life but the thought which most likely must have struck Thales’ mind are those which link water with the idea of life. Hence he observes that food and semen always contain moisture and that the very warmth of life is damp warmth. Furthermore, the composition of all things is moist and that seeds of all things have a moist nature and that water is the origin of moist. Therefore the explanation of water being the principle of things is what is contained in the content of Thales’ philosophy. Finally, on the aspect of method, philosophy wanted to explain the totality which is its object in a strictly rational manner. What is of value in philosophy is its rational arguments, its rational purpose or simply its logos. It is not enough for philosophy to confirm and find out the data derived from experience on a factual level, philosophy must go beyond the facts and experience in order to discover the reasons, the cause and the principle (Reale, 1978: 17). Therefore, Thales with a minimum amount of factual information was able by reasoning to devise an ingenious hypothesis to account for diverse things as gaseous liquid and solid characteristics of the earth, for he believed that all objects are variations of one basic ingredient-water, for water, if heated becomes steam, thus all entities which are gaseous, in its natural state is liquid, and all things which flow must be made up of it and finally, if cooled sufficiently becomes solid (Popkin, 2006: 336). Having looked at a number of things concerning the principle of Thales, we now have to look at a number of contributions which Thales brought forth to the development of philosophy. Firstly, he is believed to have paved way for materialism in metaphysics, which is simply the view that reality is essentially material, and the materialist held that reality is made up of indivisible material particles which move around in a void and combined together to form all the different kinds of things to be found in the world. In this bold speculation the materialist or atomist in particular were following in the footsteps of earlier thinkers (one of them being Thales) who had posited the key idea that underlying the apparent diversity of the world we inhabit, there is a fundamental unit. Therefore Thales is the man who is credited with being the first philosopher and he believed that this unity consisted in the fact that everything comes from or was in some sense made of water (Horner, 2000: 19). Through Thales we have also experienced the transition from explaining natural phenomena through myths to rational and scientific explanation of the origin of nature. At first when explaining the origin of all things, people in Greece referred to a poem called Theogony, written by Hessiod about 725BC. The Theogony contained myths of the gods and speculates in part about the origin and the order of the universe (Audi, 1995: 595). However, with the coming of Thales, the origin of all things was explained systematically using the method of reasoning. The other contribution of Thales to philosophy is that he began the study of cosmology which is branch of metaphysics. Cosmology is a theory of the process of reality and it deals with the science of ultimate reality as a whole. The study analyses and explains the nature of elements of which reality as a whole is underpinned and it establishes whether there are principles that may give us a fuller explanation of the nature of existence (Audi, 1995: 595). In this sense then, we see that Thales gives an account of his principle in line with cosmology, the branch of metaphysics, this therefore entails that Thales started cosmology as he was the first philosopher. Lastly, on the contributions, Thales was the first philosopher to devote himself to the study and the investigation of nature; he is generally regarded as the first who taught the Greeks the investigation of nature. Although, he had many predecessors as Theophrastus has remarked, he surpassed them all to such a degree that they are forgotten, he is as well considered to be one of the seven wise men to undertake the study of natural philosophy for he declared water to be the beginning and the end of all things (Presocratics; 1995, 42). However, despite an articulate explanation on the reasoning of Thales, his method is likely to be criticized, for the one cause that the reasoning process behind his conclusion that water is the first material principle is unknown, so that it becomes a matter of conjecture. Aristotle had no means of knowing the reasons which led Thales to make his statement and when he ascribes a possible line of thought, to him it makes no secret of the fact that he was guessing (Guthrie, 1978: 54). And when we compare the reasoning of Thales to that of other Milesians like Anaximander, Thales’ reasoning is put to the spotlight that he was just guessing because in Anaximander we clearly see that his thinking goes beyond experience, confirming that he was really contemplating rather than just guessing as Aristotle had put it. Another weakness of his explanation of a single principle that was the cause of all reality, is that he never explained the process into which water goes through to become a component of all things more specifically a thing like fire. Other philosophers like Anaximenes, who said the principle is air, explained that through the process of rarefaction air produces fire and when the air condenses through condensation, it gives origin to wind, the clouds, the water, the earth, rocks and other things. This kind of explanation is what was lacking in the philosophy of Thales. In conclusion, Thales of Miletus was one of the first Greek philosophers to seek natural causes for natural phenomena. He traveled widely throughout Egypt and the Middle East and became famous for predicting a solar eclipse that occurred in 585 BC. At a time when people regarded eclipses as ominous, inexplicable, and frightening events, his prediction marked the start of rationalism, a belief that the universe can be explained by reason alone. Rationalism remains the hallmark of science to this day. BIBLIOGRAPHY Audi, R. (1992). Cambridge Dictionary of Philosophy. Cambridge University Press, New York. Guthrie, A. (1978). A history of Greek Philosophy. Vol 1. Cambridge University Press, Britain. Radhakrishnan, S. (1953). History of Philosophy, Eastern and Western. Vol 2. George Allen Unwin Ltd, London. Reale, G. A. (1987). History of Ancient Philosophy From the Origins to Socrates. State University of New York, New York.

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

Coming of Age in A Tree Grows in Brooklyn :: essays research papers

Betty Smith’s A Tree Grows in Brooklyn presents the problems of a young girl coming of age, a time when she is faced with new challenges and must overcome obstacles. Throughout the book the protagonist, Francie Nolan discovers herself maturing as she struggles with loneliness, the loss of innocence and a life of poverty in a Brooklyn slum. This theme is evident in (1.) her love for books which she uses as companionship, (2.) her outlook on the world as she matures and finally, (3.) her realization that in order to succeed in life she must obtain an education and work hard to do it. One of the biggest challenges Francie faces while growing up is loneliness. As a young child living in a Brooklyn slum, Francie has no friends her age. The other children either find her too quiet or shun her for being different because of her extensive vocabulary. Betty Smith describes how most of Francie's childhood days are spent: "in the warm summer days the lonesome child sat on her stoop and pretended disdain for the group of children playing on the sidewalk. Francie played with her imaginary companions and made believe they were better than real children. But all the while her heart beat in rhythm to the poignant sadness of the song the children sang while walking around in a ring with hands joined." (106). Francie is lonely, and longs to be included. As Francie matures, she begins to experience a different kind of loneliness. Betty Smith portrays her feelings as she observes her neighborhood: "spring came early that year and the sweet warm nights made her restless. She wal ked up and down the streets and through the park. And wherever she went, she saw a boy and a girl together, walking arm-in-arm, sitting on a park bench with their arms around each other, standing closely and in silence in a vestibule. Everyone in the world but Francie had a sweetheart or a friend she seemed to be the only lonely one in Brooklyn without a friend." (403). Loneliness is a constant challenge for Francie but it is through her loneliness that she finds a new companion in her books. Francie reads as an alternative for her lack of friends and companions. It is through her love of reading that Francie develops her extensive, sophisticated vocabulary. Her books lead her into maturity and help her learn to be independent and overcome her many hardships.

The Return :: essays research papers

The Return Essay   Ã‚  Ã‚  Ã‚  Ã‚  The novel The Return, written by Sonia Levitin, is a fascinating novel written to show the oppression that Ethiopian Jews suffer. The Return is about a young Ethiopian Jewish woman named Desta, who, with her immediate family, travels to Israel for freedom. During this journey, her brother Joas is shot and dies, she has difficulty finding the group she is supposed to walk with, and she has to stay in a refugee camp for a short period of time. Finally, she reaches her destination and lives in Israel from then on. There are three main topics illustrated in this novel. Prejudice and its effects, maturing and finding one’s own identity, and joining together to achieve common goals.   Ã‚  Ã‚  Ã‚  Ã‚  Prejudice against Ethiopian Jews plays a big role in the Jews’ lives. For example, early on in the novel, Joas makes Desta realize that Ethiopian Jews are not even allowed to pray aloud. This relates to prejudice and its effects because praying aloud is very important for Jews and taking that away from them is the ultimate form of oppression. Furthermore, the novel explains that Ethiopian Jews are called Falasha (strangers) even though they have lived in Ethiopia for generations and are citizens. This is an example of the prejudice because calling an entire section of the population strangers makes them feel like outsiders. Also, when Desta and her aunt want to sell their pottery, the other Ethiopians pay them an unfair price. The prejudice against Ethiopian Jews is illustrated by the fact that non-Jewish Ethiopians cheat Jewish Ethiopians in commerce. Finally, when Desta and Almaz go to a small town on the way to Israel, the people of the town begin shouti ng at them, â€Å"You are buda, go before we kill you!† The people also refuse to give them food even though they are obviously starving. This episode in the novel shows the racial hatred felt by many against Jews.   Ã‚  Ã‚  Ã‚  Ã‚  During the journey to Israel, maturing and finding one’s own identity plays a big part in Desta’s and her family’s lives. For example, when Joas is shot, Desta has to take care of her younger sister and lead the way to Israel. This shows maturing on Desta’s part because now she is the one in charge, she is able to take care of her younger sister and get food so that she and her sister do not starve and she never gives up on going to Israel.

Microenvironmental Factors Affecting Toyota Essay

Microenvironmental factors are â€Å"The factors close to the company that affect its ability to serve its customers† [principles of marketing]. The microenvironmental factors that affected the introduction and sale of the Toyota Prius were it customers, competitors and publics. Customers are anyone who buys or rents from the company. Customer are the most important microenvironmental factor that affect company as they survive on meeting the wants and needs of the customer and failure to do so will result in the company failing. Toyota study their customers and saw that they wanted a car with better fuel consumption and as a result Toyota decided to make the Prius, their first hybrid car. Toyota dealt with their customers by setting up website to educate the customers about the Toyota Prius. They took advantage of Earth Day to send out green seed cards shaped like Toyota’s logo to prospective buyers and they also gave away some green Prius at Earth Day events. However, Toyota did not recognise that consumers normally don’t buy cars for the saving in the long-run so â€Å"fuel savings are not going to be the key it convincing people to purchase the Prius† [principles of marketing]. As a result of this Toyota have asked governments to give tax cuts to cars with better fuel consumption. Competitors are any company in the same market place as your company. In order of a company to be successful in the market place a competitors most grain a competitive advantage over its competitors. Toyota has been successful in maintaining its competitive advantage although competitors like Citroen have cars which are just as efficient as the Toyota Prius, â€Å"Toyota is still the market leader in this segment† [principles of marketing]. They have done this by capturing people imagination by being the first Hybrid car on the market and through the effective use of advertisement. Publics are any group that has an actual or potential interest in an organisation’s ability to achieve its objectives. Good relations with the public help to enhance the company’s reputation so helping to increase in sales. The biggest factors of the Toyota Prius’ microenvironment are media and the government. Toyota has worked with Government bodies and has asked for tax incentives encourage people to buy more environmentally friendly cars to increase the amount of hybrids sold. Toyota also has spent 15m of its 200m annual marketing budget on the Prius. It has introduction ads that appealed more to peoples’ emotion to get them to buy the Prius. Overall, Toyota has analysed its icroenvironment extremely well as it has maintaining its competitive advantage over it competitors and has sold over 1m Prius with the waiting list of the Prius waiting list being over 18 month and becoming a status symbol among Hollywood stars. Question 2: The macro environment consists of six forces that affect the whole microenvironment, demographic, economic, natural, technological, political and cultural forces. The Toyota Prius is such a highly technologically advanced vehicle with its four cylinder petrol engine and 33-kilowatt electric motor. This could be one of the demographic factors that prompted the introduction of the Prius for Toyota. The Prius appeals to Generation Y also known as the â€Å"echo boomers† who were born between 1977 and 1994. Their comfort with computers, digital technology and overall technical advances prove they are and attractive target for marketers wanting to create a device at the high end of new, innovative devices on the market today e. g. iPad , Toyota Prius. The economic environment consists of the factors that affect consumer buying power and spending patterns. With many countries experiencing economic recession, consumer purchasing power is reduced. People have less money and now have to spend more carefully. The recent high petrol prices are causing a rising demand for greener, more fuel efficient cars that are cheaper to run. Several governments are providing incentives to people to buy these hybrid cars. In the UK, the government is offering reduced car tax on initial purchase. Electric car drivers can also avoid the ? 8 per day Congestion Charge in London. Toyota must be aware of and keep up with the technological environment which includes the forces that create new technologies, creating new product and market opportunities. This is the most rapidly changing environment. By introducing the Toyota Prius, the company has gained a technological initiative in the hybrid market. Toyota knew that their target market for this product would include technology enthusiasts, or ‘techies’ as they are known, and included reference to the cars leading technology in their advertisements. Natural forces also affected Toyotas decision to manufacture a hybrid car. Consumers are becoming more concerned about the environment and about how the products they purchase have an effect on it. Petrol and diesel are both non-renewable fossil fuels which release carbon emissions that contribute to global warming. Therefore there is a demand in the market for alternatives to petrol-powered vehicles, such as electric cars. Hybrid cars like the Toyota Prius offer improved gas mileage and emissions standards. Toyota have used this opportunity to position themselves in the market as an ‘environmentally concerned company’ Toyota needs however, to be aware of the political environment which may pose restrictions on its business activity. The political environment includes laws, government agencies and pressure groups that influence and limit various organisations and individuals in a given society. Recently, the EU commission announced new legislation which will be brought in that requires all manufacturers selling cars in the European Union to lower average CO2 emissions of new cars. The governments of some countries have intervened and offered tax incentives to stimulate the purchase of clean-fuel and high-mileage hybrid cars. Cultural values have an effect on the products people choose to buy. Although core values and beliefs held by society are quite persistent, secondary cultural values are more open to change. Recent changes in cultural values include a greater appreciation for nature. People are starting to realise that nature is finite and fragile. They are beginning to seek out more environmentally-friendly products, one of these being fuel-efficient cars. Toyota has responded to this by introducing the Toyota Prius onto the market. Even in Hollywood it seems that it is now cool to be environmentally responsible as a range of A-listers are now owners this hybrid car. Question 3:  Toyota has ran a masterful marketing campaign so far. It has become the â€Å"environmentally concerned† car manufacturer and the technology leader in the hybrid car market. It has targeted â€Å"techies† and early adopters by educating consumers about the new car. Toyota have used the power of the internet to promote the Prius. The first thing they did was educate consumers about the prius. They launched a website to distribute the information and sent 40000 e-brochures to likely buyers. It worked. The Prius â€Å"flew out of dealer’s showrooms† and they even had difficulty â€Å"keeping up with demand†. They also ran print ads with tag lines such as â€Å"when it sees red it charges†, an emotional reference, and they ran television ads as well. By using these marketing tools to great effect the company was firmly established as a caring brand in the consumer’s mind. The new â€Å"environmentally concerned† Toyota is clearly a hit with customers as it sold 400000 hybrids in 2006 alone. It has even succeeded in making being green cool as a host of Hollywood celebrities like Cameron Diaz and even Arnold Schwarzenegger has one to park, ironically, beside his giant hummer. Another effective strategy was to become the market leader in a new technology. It was risky to jump into the market that soon as it could have cost the company a lot of money if it didn’t work out. Toyota always subtly stresses the technology aspect of the car in its advertising. Surprisingly hybrids aren’t all that efficient. The citroen CZ, C1 and C3 all have better fuel consumption than the Prius, but it doesn’t matter as Toyota â€Å"have captured people’s minds†. It’s marketing campaigns have won over the environmentally conscious companies like IKEA, who are switching their car fleet to hybrids. Toyota’s efforts have left other car makers â€Å"racing to catch up†. Marketing segmentation was used to great effect by Toyota. It set out very early on to target the â€Å"techies† and the â€Å"early adapters† through emails and the online website. â€Å"Many Prius owners are immersed in technology†, they even have their own website called â€Å"Priusenvy. com†. It really has taken off with the â€Å"techies†. They were able to make changes such as â€Å"cruise control† and a â€Å"sniffer† to the car without the help of a qualified mechanic or engineer. This success can be attributed to the narrow targeting of the cars. Toyota could improve its strategy by appealing more to the general market for cars. Today the cost of a Prius is significantly lower than it was when it first came out. Perhaps it’s time to focus on what a great small family car it would make or how it might suit a professional, like a teacher for example. There are many environmentally conscious people among the ranks of the middle class families of Ireland. By honing in on the small family market Toyota could bring an alternative to the Ford Mondeo and the Volkswagon Passet. Overall Toyota has done almost everything right with the Prius. When we think â€Å"Hybrid† we think â€Å"Prius† exactly like â€Å"MP3† and â€Å"iPod†. That is the sign of an extremely efficient marketing campaign.